Using policy theories to interpret public health case studies: the example of a minimum unit price for alcohol

By James Nicholls and Paul Cairney, for the University of Stirling MPH and MPP programmes.

There are strong links between the study of public health and public policy. For example, public health scholars often draw on policy theories to help explain (often low amounts of) policy change to foster population health or reduce health inequalities. Studies include a general focus on public health strategies (such as HiAP) or specific policy instruments (such as a ban on smoking in public places). While public health scholars may seek to evaluate or influence policy, policy theories tend to focus on explaining processes and outcomes.

To demonstrate these links, we present:

1. A long-read blog post to (a) use an initial description of a key alcohol policy instrument (minimum unit pricing, adopted by the Scottish Government but not the UK Government) to (b) describe the application of policy concepts and theories and reflect on the empirical and practical implications. We then added some examples of further reading.
2. A 45 minute podcast to describe and explain these developments (click below or scroll to the end)

Minimum Unit Pricing in Scotland: background and development

Minimum Unit Pricing for alcohol was introduced in Scotland in 2018. In 2012, the UK Government had also announced plans to introduce MUP, but within a year dopped the policy following intense industry pressure. What do these two journeys tell us about policy processes?

When MUP was first proposed by Scottish Health Action on Alcohol Problems in 2007, it was a novel policy idea. Public health advocates had long argued that raising the price of alcohol could help tackle harmful consumption. However, conventional tax increases were not always passed onto consumers, so would not necessarily raise prices in the shops (and the Scottish Government did not have such taxation powers). MUP appeared to present a neat solution to this problem. It quickly became a prominent policy goal of public health advocates in Scotland and across the UK, while gaining increasing attention, and support, from the global alcohol policy community.

In 2008, the UK Minister for Health, Dawn Primarolo, had commissioned researchers at the University of Sheffield to look into links between alcohol pricing and harm. The Sheffield team developed economic models to analysis the predicted impact of different systems. MUP was included, and the ‘Sheffield Model’ would go on to play a decisive role in developing the case for the policy.

What problem would MUP help to solve?

Descriptions of the policy problem often differed in relation to each government. In the mid-2000s, alcohol harm had become a political problem for the UK government. Increasing consumption, alongside changes to the night-time economy, had started to gain widespread media attention. In 2004, just as a major liberalisation of the licensing system was underway in England, news stories began documenting the apparent horrors of ‘Binge Britain’: focusing on public drunkenness and disorder, but also growing rates of liver disease and alcohol-related hospital admissions.

In 2004, influential papers such as the Daily Mail began to target New Labour alcohol policy

Politicians began to respond, and the issue became especially useful for the Conservatives who were developing a narrative that Britain was ‘broken’ under New Labour. Labour’s liberalising reforms of alcohol licensing could conveniently be linked to this political framing. The newly formed Alcohol Health Alliance, a coalition set up under the leadership of Professor Sir Ian Gilmore, was also putting pressure on the UK Government to introduce stricter controls. In Scotland, while much of the debate on alcohol focused on crime and disorder, Scottish advocates were focused on framing the problem as one of public health. Emerging evidence showed that Scotland had dramatically higher rates of alcohol-related illness and death than the rest of Europe – a situation strikingly captured in a chart published in the Lancet.

Source: Leon, D. and McCambridge, J. (2006). Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 367

The notion that Scotland faced an especially acute public health problem with alcohol was supported by key figures in the increasingly powerful Scottish National Party (in government since 2007), which, around this time, had developed working relationships with Alcohol Focus Scotland and other advocacy groups.

What happened next?

The SNP first announced that it would support MUP in 2008, but it did not implement this change until 2018. There are two key reasons for the delay:

1. Its minority government did not achieve enough parliamentary support to pass legislation. It then formed a majority government in 2011, and its legislation to bring MUP into law was passed in 2012.  
2. Court action took years to resolve. The alcohol industry, which is historically powerful in Scotland, was vehemently opposed. A coalition of industry bodies, led by the Scotch Whisky Association, took the Scottish Government to court in an attempt to prove the policy was illegal. Ultimately, this process would take years, and conclude in rulings by the European Court of Justice (2016), Scottish Court of Session Inner House (2016), and UK Supreme Court (2017) which found in favour of the Scottish Government.

In England, to the surprise of many people, the Coalition Government announced in March 2012 that it too would introduce MUP, specifically to reduce binge drinking and public disorder. This different framing was potentially problematic, however, since the available evidence suggested (and subsequent evaluation has confirmed) that MUP would have only a small impact on crime. Nonetheless, health advocates were happy,  with one stating that ‘I do not mind too much how it was framed. What I mind about is how it measures up’.

Once again, the alcohol industry swung into action, launching a campaign led by the Wine and Spirits Trade Association, asking ‘Why should moderate drinkers pay more?’

This public campaign was accompanied by intense behind-the-scenes lobbying, aided by the fact that the leadership of industry groups had close ties to Government and that the All-Party Parliamentary Group on Beer had the largest membership of any APPG in Westminster. The industry campaign made much of the fact there was little evidence to suggest MUP would reduce crime, but also argued strongly that the modelling produced by Sheffield University was not valid evidence in the first place. A year after the adopting the policy, the UK Government announced a U-turn and MUP was dropped.

How can we use policy theories and concepts to interpret these dynamics?

Here are some examples of using policy theories and concepts as a lens to interpret these developments.

1. What was the impact of evidence in the case for policy change?

While public health researchers often expect (or at least promote) ‘evidence based’ policymaking, insights from research identify three main reasons why policymakers do not make evidence-based choices:

First, many political actors (including policymakers) have many different ideas about what counts as good evidence.

The assessment, promotion, and use of evidence is highly contested, and never speaks for itself.

Second, policymakers have to ignore almost all evidence to make choices.

They address ‘bounded rationality’ by using two cognitive shortcuts: ‘rational’ measures set goals and identify trusted sources, while ‘irrational’ measures use gut instinct, emotions, and firmly held beliefs.

Third, policymakers do not control the policy process.

There is no centralised and orderly policy cycle. Rather, policymaking involves policymakers and influencers spread across many authoritative ‘venues’, with each venue having its own rules, networks, and ways of thinking.

In that context, policy theories identify the importance of contestation between policy actors, and describe the development of policy problems, and how evidence fits in. Approaches include:

The study of framing

The acceptability of a policy solution will often depend on how the problem is described. Policymakers use evidence to reduce uncertainty, or a lack of information around problems and how to solve them. However, politics is about exercising power to reduce ambiguity, or the ability to interpret the same problem in different ways.

By suggesting MUP would solve problems around crime, the UK Government made it easier for opponents to claim the policy wasn’t evidence-based. In Scotland, policymakers and advocates focused on health, where the evidence was stronger. In addition, the SNP’s approach fitted within a wider political independence frame, in which more autonomy meant more innovation.

The Narrative Policy Framework

Policy actors tell stories to appeal to the beliefs (or exploit the cognitive shortcuts) of their audiences. A narrative contains a setting (the policy problem), characters (such as the villain who caused it, or the victim of its effects), plot (e.g. a heroic journey to solve the problem), and moral (e.g. the solution to the problem).

Supporters of MUP tended to tell the story that there was an urgent public health  crisis, caused largely by the alcohol industry, and with many victims, but that higher alcohol prices pointed to one way out of this hole. Meanwhile opponents told the story of an overbearing ‘nanny state’, whose victims – ordinary, moderate drinkers – should be left alone by government.

Social Construction and Policy Design

Policymakers make strategic and emotional choices, to identify ‘good’ populations deserving of government help, and ‘bad’ populations deserving punishment or little help. These judgements inform policy design (government policies and practices) and provide positive or dispiriting signals to citizens.

For example, opponents of MUP rejected the idea that alcohol harms existed throughout the population. They focused instead on dividing the majority of moderate drinkers from irresponsible minority of binge drinkers, suggesting that MUP would harm the former more than help the latter.

Multi-centric policymaking

This competition to frame policy problems takes place in political systems that contain many ‘centres’, or venues for authoritative choice. Some diffusion of power is by choice, such as to share responsibilities with devolved and local governments. Some is by necessity, since policymakers can only pay attention to a small proportion of their responsibilities, and delegate the rest to unelected actors such as civil servants and public bodies (who often rely on interest groups to process policy).

For example, ‘alcohol policy’ is really a collection of instruments made or influenced by many bodies, including (until Brexit) European organisations deciding on the legality of MUP, UK and Scottish governments, as well as local governments responsible for alcohol licensing. In Scotland, this delegation of powers worked in favour of MUP, since Alcohol Focus Scotland were funded by the Scottish Government to help deliver some of their alcohol policy goals, and giving them more privileged access than would otherwise have been the case.

The role of evidence in MUP

In the case of MUP, similar evidence was available and communicated to policymakers, but used and interpreted differently, in different centres, by the politicians who favoured or opposed MUP.

In Scotland, the promotion, use of, and receptivity to research evidence – on the size of the problem and potential benefit of a new solution – played a key role in increasing political momentum. The forms of evidence were complimentary. The ‘hard’ science on a potentially effective solution seemed authoritative (although few understood the details), and was preceded by easily communicated and digested evidence on a concrete problem:

1. There was compelling evidence of a public health problem put forward by a well-organised ‘advocacy coalition’ (see below) which focused clearly on health harms. In government, there was strong attention to this evidence, such as the Lancet chart which one civil servant described as ‘look[ing] like the north face of the Eiger’. There were also influential ‘champions’ in Government willing to frame action as supporting the national wellbeing.
2. Reports from Sheffield University appeared to provide robust evidence that MUP could reduce harm, and advocacy was supported by research from Canada which suggested that similar policies there had been successful elsewhere.

Advocacy in England was also well-organised and influential, but was dealing with a larger – and less supportive – Government machine, and the dominant political frame for alcohol harms remained crime and disorder rather than health.

Debates on MUP modelling exemplify these differences in evidence communication and use. Those in favour appealed to econometric models, but sometimes simplifying their complexity and blurring the distinction between projected outcomes and proof of efficacy. Opponents went the other way and dismissed the modelling as mere speculation. What is striking is the extent to which an incredibly complex, and often poorly understand, set of econometric models – and the ’Sheffield Model’ in particular – came to occupy centre stage in a national policy debate. Katikireddi and colleagues talked about this as an example of evidence as rhetoric:

1. Support became less about engagement with  the econometric modelling, and more an indicator of general concern about alcohol harm and the power of the industry.
2. Scepticism was often viewed as the ‘industry position’, and an indicator of scepticism towards public health policy more broadly.

2. Who influences policy change?

Advocacy plays a key role in alcohol policy, with industry and other actors competing with public health groups to define and solve alcohol policy problems. It prompts our attention to policy networks, or the actors who make and influence policy.

According to the Advocacy Coalition Framework:

People engage in politics to turn their beliefs into policy. They form advocacy coalitions with people who share their beliefs, and compete with other coalitions. The action takes place within a subsystem devoted to a policy issue, and a wider policymaking process that provides constraints and opportunities to coalitions. Beliefs about how to interpret policy problems act as a glue to bind actors together within coalitions. If the policy issue is technical and humdrum, there may be room for routine cooperation. If the issue is highly charged, then people romanticise their own cause and demonise their opponents.

MUP became a highly charged focus of contestation between a coalition of public health advocates, who saw themselves as fighting for the wellbeing of the wider community (and who believed fundamentally that government had a duty to promote population health), and a coalition of industry actors who were defending their commercial interests, while depicting public health policies as illiberal and unfair.

3. Was there a ‘window of opportunity’ for MUP?

Policy theories – including Punctuated Equilibrium Theory – describe a tendency for policy change to be minor in most cases and major in few. Paradigmatic policy change is rare and may take place over decades, as in the case of UK tobacco control where many different policy instruments changed from the 1980s. Therefore, a major change in one instrument could represent a sea-change overall or a modest adjustment to the overall approach.

Multiple Streams Analysis is a popular way to describe the adoption of a new policy solution such as MUP. It describes disorderly policymaking, in which attention to a policy problem does not produce the inevitable development, implementation, and evaluation of solutions. Rather, these ‘stages’ should be seen as separate ‘streams’.  A ‘window of opportunity’ for policy change occurs when the three ‘streams’ come together:

• Problem stream. There is high attention to one way to define a policy problem.
• Policy stream. A technically and politically feasible solution already exists (and is often pushed by a ‘policy entrepreneur’ with the resources and networks to exploit opportunities).
• Politics stream. Policymakers have the motive and opportunity to choose that solution.

However, these windows open and close, often quickly, and often without producing policy change.

This approach can help to interpret different developments in relation to Scottish and UK governments:

Problem stream

• The Scottish Government paid high attention to public health crises, including the role of high alcohol consumption.
• The UK government paid often-high attention to alcohol’s role in crime and anti-social behaviour (‘Binge Britain’ and ‘Broken Britain’)

Policy stream

• In Scotland, MUP connected strongly to the dominant framing, offering a technically feasible solution that became politically feasible in 2011.
• The UK Prime Minister David Cameron’s made a surprising bid to adopt MUP in 2012, but ministers were divided on its technical feasibility (to address the problem they described) and its political feasibility seemed to be more about distracting from other crises than public health.

Politics stream

• The Scottish Government was highly motivated to adopt MUP. MUP was a flagship policy for the SNP; an opportunity to prove its independent credentials, and to be seen to address a national public health problem. It had the opportunity from 2011, then faced interest group opposition that delayed implementation.
• The Coalition Government was ideologically more committed to defending commercial interests, and to framing alcohol harms as one of individual (rather than corporate) responsibility. It took less than a year for the alcohol industry to successfully push for a UK government U-turn.

As a result, MUP became policy (eventually) in Scotland, but the window closed (without resolution) in England.

Further Reading

Nicholls, J. and Greenaway, J. (2015) ‘What is the problem?: Evidence, politics and alcohol policy in England and Wales, 2010–2014’, Drugs: Education, Prevention and Policy 22.2  https://doi.org/10.3109/09687637.2014.993923

Butler, S., Elmeland, K., Nicholls, J. and Thom, B. (2017) Alcohol, power and public health: a comparative study of alcohol policy. Routledge.

Fitzgerald, N. and Angus, C. (2015) Four nations: how evidence–based are alcohol policies and programmes across the UK?

Holden, C. and Hawkins, B. (2013) ‘Whisky gloss’: the alcohol industry, devolution and policy communities in Scotland. Public Policy and Administration, 28(3), pp.253-273.

Paul Cairney and Donley Studlar (2014) ‘Public Health Policy in the United Kingdom: After the War on Tobacco, Is a War on Alcohol Brewing?’ World Medical and Health Policy, 6, 3, 308-323 PDF

Niamh Fitzgerald and Paul Cairney (2022) ‘National objectives, local policymaking: public health efforts to translate national legislation into local policy in Scottish alcohol licensing’, Evidence and Policy, https://doi.org/10.1332/174426421X16397418342227, PDF

Podcast

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Using policy theories to interpret public health case studies: the example of a minimum unit price for alcohol – Understanding Public Policy (in 1000 and 500 words)

By James Nicholls and Paul Cairney, for the University of Stirling MPH and MPP programmes. There are strong links between the study of public health and public policy. For example, public health scholars often draw on policy theories to help explain (often low amounts of) policy change to foster population health or reduce health inequalities. Studies include a general focus on public health strategies (such as HiAP) or specific policy instruments (such as a ban on smoking in public places). While public health scholars may seek to evaluate or influence policy, policy theories tend to focus on explaining processes and outcomes,. To demonstrate these links, we present this podcast and blog post to (1) use an initial description of a key alcohol policy instrument (minimum unit pricing in Scotland) to (2) describe the application of policy concepts and theories and reflect on the empirical and practical implications.  Using policy theories to interpret public health case studies: the example of a minimum unit price for alcohol | Paul Cairney: Politics & Public Policy (wordpress.com)

1. Using policy theories to interpret public health case studies: the example of a minimum unit price for alcohol 47:09
2. Policy in 500 Words: policymaking environments and their consequences 11:47
3. Policy in 500 Words: bounded rationality and its consequences 18:39
4. Policy in 500 Words: evolutionary theory 51:09
5. Policy in 500 Words: The Advocacy Coalition Framework 33:19

The COVID-19 exams fiasco across the UK: why did policymaking go so wrong?

This post first appeared on the LSE British Politics and Policy blog, and it summarises our new article: Sean Kippin and Paul Cairney (2021) ‘The COVID-19 exams fiasco across the UK: four nations and two windows of opportunity’, British Politics, PDF & Annex. The focus on inequalities of attainment is part of the IMAJINE project on spatial justice and territorial inequalities.

In the summer of 2020, after cancelling exams, the UK and devolved governments sought teacher estimates on students’ grades, but supported an algorithm to standardise the results. When the results produced a public outcry over unfair consequences, they initially defended their decision but reverted quickly to teacher assessment. These experiences, argue Sean Kippin and Paul Cairney, highlight the confluence of events and choices in which an imperfect and rejected policy solution became a ‘lifeline’ for four beleaguered governments. 

In 2020, the UK and devolved governments performed a ‘U-turn’ on their COVID-19 school exams replacement policies. The experience was embarrassing for education ministers and damaging to students. There are significant differences between (and often within) the four nations in terms of the structure, timing, weight, and relationship between the different examinations. However, in general, the A-level (England, Northern Ireland, Wales) and Higher/ Advanced Higher (Scotland) examinations have similar policy implications, dictating entry to further and higher education, and influencing employment opportunities. The Priestley review, commissioned by the Scottish Government after their U-turn, described this as an ‘impossible task’.

Initially, each government defined the new policy problem in relation to the need to ‘credibly’ replicate the purpose of exams to allow students to progress to tertiary education or employment. All four quickly announced their intentions to allocate in some form grades to students, rather than replace the assessments with, for example, remote examinations. However, mindful of the long-term credibility of the examinations system and of ensuring fairness, each government opted to maintain the qualifications and seek a similar distribution of grades to previous years. A key consideration was that UK universities accept large numbers of students from across the UK.

One potential solution open to policymakers was to rely solely on teacher grading (CAG). CAGs are ‘based on a range of evidence including mock exams, non-exam assessment, homework assignments and any other record of student performance over the course of study’. Potential problems included the risk of high variation and discrepancies between different centres, the potential overload of the higher education system, and the tendency for teacher predicted grades to reward already privileged students and punish disabled, non-white, and economically deprived children.

A second option was to take CAGs as a starting point, then use an algorithm to produce ‘standardisation’, which was potentially attractive to each government as it allowed students to complete secondary education and to progress to the next level in similar ways to previous (and future) cohorts. Further, an emphasis on the technical nature of this standardisation, with qualifications agencies taking the lead in designing the process by which grades would be allocated, and opting not share the details of its algorithm were a key part of its (temporary) viability. Each government then made similar claims when defending the problem and selecting the solution. Yet this approach reduced both the debate on the unequal impact of this process on students, and the chance for other experts to examine if the algorithm would produce the desired effect. Policymakers in all four governments assured students that the grading would be accurate and fair, with teacher discretion playing a large role in the calculation of grades.

To these governments, it appeared at first that they had found a fair and efficient (or at least defendable) way to allocate grades, and public opinion did not respond negatively to its announcement. However, these appearances proved to be profoundly deceptive and vanished on each day of each exam result. The Scottish national mood shifted so intensely that, after a few days, pursuing standardisation no longer seemed politically feasible. The intense criticism centred on the unequal level of reductions of grades after standardisation, rather than the unequal overall rise in grade performance after teacher assessment and standardisation (which advantaged poorer students).

Despite some recognition that similar problems were afoot elsewhere, this shift of problem definition did not happen in the rest of the UK until (a) their published exam results highlighted similar problems regarding the role of previous school performance on standardised results, and (b) the Scottish Government had already changed course. Upon the release of grades outside Scotland, it became clear that downgrades were also concentrated in more deprived areas. For instance, in Wales, 42% of students saw their A-Level results lowered from their Centre Assessed Grades, with the figure close to a third for Northern Ireland.

Each government thus faced similar choices between defending the original system by challenging the emerging consensus around its apparent unfairness; modifying the system by changing the appeal system; or abandoning it altogether and reverting to solely teacher assessed grades. Ultimately, all three governments followed the same path. Initially, they opted to defend their original policy choice. However, by 17 August, the UK, Welsh, and Northern education secretaries announced (separately) that examination grades would be based solely on CAGs – unless the standardisation process had generated a higher grade (students would receive whichever was highest).

Scotland’s initial experience was instructive to the rest of the UK and its example provided the UK government with a blueprint to follow (eventually). It began with a new policy choice – reverting to teacher assessed grades – sold as fairer to victims of the standardisation process. Once this precedent had been set, a different course for policymakers at the UK level became difficult to resist, particularly when faced with a similar backlash. The UK’s government’s decision in turn influenced the Welsh and Northern Irish governments.

In short, we can see that the particular ordering of choices created a cascading effect across the four governments which created initially one policy solution, before triggering a U-turn. This focus on order and timing should not be lost during the inevitable inquiries and reports on the examinations systems. The take-home message is to not ignore the policy process when evaluating the long-term effect of these policies. Focus on why the standardisation processes went wrong is welcome, but we should also focus on why the policymaking process malfunctioned, to produce a wildly inconsistent approach to the same policy choice in such a short space of time. Examining both aspects of this fiasco will be crucial to the grading process in 2021, given that governments will be seeking an alternative to exams for a second year.

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Note: the above draws on the authors’ published work in British Politics.

What have we learned so far from the UK government’s COVID-19 policy?

This post first appeared on LSE British Politics and Policy (27.11.20) and is based on this article in British Politics.

Paul Cairney assesses government policy in the first half of 2020. He identifies the intense criticism of its response so far, encouraging more systematic assessments grounded in policy research.

In March 2020, COVID-19 prompted policy change in the UK at a speed and scale only seen during wartime. According to the UK government, policy was informed heavily by science advice. Prime Minister Boris Johnson argued that, ‘At all stages, we have been guided by the science, and we will do the right thing at the right time’. Further, key scientific advisers such as Sir Patrick Vallance emphasised the need to gather evidence continuously to model the epidemic and identify key points at which to intervene, to reduce the size of the peak of population illness initially, then manage the spread of the virus over the longer term.

Both ministers and advisors emphasised the need for individual behavioural change, supplemented by government action, in a liberal democracy in which direct imposition is unusual and unsustainable. However, for its critics, the government experience has quickly become an exemplar of policy failure.

Initial criticisms include that ministers did not take COVID-19 seriously enough in relation to existing evidence, when its devastating effect was apparent in China in January and Italy from February; act as quickly as other countries to test for infection to limit its spread; or introduce swift-enough measures to close schools, businesses, and major social events. Subsequent criticisms highlight problems in securing personal protective equipment (PPE), testing capacity, and an effective test-trace-and-isolate system. Some suggest that the UK government was responding to the ‘wrong pandemic’, assuming that COVID-19 could be treated like influenza. Others blame ministers for not pursuing an elimination strategy to minimise its spread until a vaccine could be developed. Some criticise their over-reliance on models which underestimated the R (rate of transmission) and ‘doubling time’ of cases and contributed to a 2-week delay of lockdown. Many describe these problems and delays as the contributors to the UK’s internationally high number of excess deaths.

How can we hold ministers to account in a meaningful way?

I argue that these debates are often fruitless and too narrow because they do not involve systematic policy analysis, take into account what policymakers can actually do, or widen debate to consider whose lives matter to policymakers. Drawing on three policy analysis perspectives, I explore the questions that we should ask to hold ministers to account in a way that encourages meaningful learning from early experience.

These questions include:

Was the government’s definition of the problem appropriate?
Much analysis of UK government competence relates to specific deficiencies in preparation (such as shortages in PPE), immediate action (such as to discharge people from hospitals to care homes without testing them for COVID-19), and implementation (such as an imperfect test-trace-and-isolate system). The broader issue relates to its focus on intervening in late March to protect healthcare capacity during a peak of infection, rather than taking a quicker and more precautionary approach. This judgment relates largely to its definition of the policy problem which underpins every subsequent policy intervention.

Did the government select the right policy mix at the right time? Who benefits most from its choices?

Most debates focus on the ‘lock down or not?’ question without exploring fully the unequal impact of any action. The government initially relied on exhortation, based on voluntarism and an appeal to social responsibility. Initial policy inaction had unequal consequences on social groups, including people with underlying health conditions, black and ethnic minority populations more susceptible to mortality at work or discrimination by public services, care home residents, disabled people unable to receive services, non-UK citizens obliged to pay more to live and work while less able to access public funds, and populations (such as prisoners and drug users) that receive minimal public sympathy. Then, in March, its ‘stay at home’ requirement initiated a major new policy and different unequal impacts in relation to the income, employment, and wellbeing of different groups. These inequalities are list in more general discussions of impacts on the whole population.

Did the UK government make the right choices on the trade-offs between values, and what impacts could the government have reasonably predicted?

Initially, the most high-profile value judgment related to freedom from state coercion to reduce infection versus freedom from the harm of infection caused by others. Then, values underpinned choices on the equitable distribution of measures to mitigate the economic and wellbeing consequences of lockdown. A tendency for the UK government to project centralised and ‘guided by the science’ policymaking has undermined public deliberation on these trade-offs between policies. The latter will be crucial to ongoing debates on the trade-offs associated with national and regional lockdowns.

Did the UK government combine good policy with good policymaking?

A problem like COVID-19 requires trial-and-error policymaking on a scale that seems incomparable to previous experiences. It requires further reflection on how to foster transparent and adaptive policymaking and widespread public ownership for unprecedented policy measures, in a political system characterised by (a) accountability focused incorrectly on strong central government control and (b) adversarial politics that is not conducive to consensus seeking and cooperation.

These additional perspectives and questions show that too-narrow questions – such as was the UK government ‘following the science’ – do not help us understand the longer term development and wider consequences of UK COVID-19 policy. Indeed, such a narrow focus on science marginalises wider discussions of values and the populations that are most disadvantaged by government policy.

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The UK government’s lack of control of public policy

This post first appeared as Who controls public policy? on the UK in a Changing Europe website. There is also a 1-minute video, but you would need to be a completist to want to watch it.

Our #AcademicintheSpotlight series highlights social scientists doing innovative & dynamic research that you really ought to be aware of.

This week, it’s the turn of @CairneyPaul. Paul works on understanding the mechanics of public policy and policymaking. Interested? Read on… pic.twitter.com/bMs8RoQi2a

— The UK in a Changing Europe (@UKandEU) September 30, 2020

Most coverage of British politics focuses on the powers of a small group of people at the heart of government. In contrast, my research on public policy highlights two major limits to those powers, related to the enormous number of problems that policymakers face, and to the sheer size of the government machine.

First, elected policymakers simply do not have the ability to properly understand, let alone solve, the many complex policy problems they face. They deal with this limitation by paying unusually high attention to a small number of problems and effectively ignoring the rest.

Second, policymakers rely on a huge government machine and network of organisations (containing over 5 million public employees) essential to policy delivery, and oversee a statute book which they could not possibly understand.

In other words, they have limited knowledge and even less control of the state, and have to make choices without knowing how they relate to existing policies (or even what happens next).

These limits to ministerial powers should prompt us to think differently about how to hold them to account. If they only have the ability to influence a small proportion of government business, should we blame them for everything that happens in their name?

My approach is to apply these general insights to specific problems in British politics. Three examples help to illustrate their ability to inform British politics in new ways.

First, policymaking can never be ‘evidence based’. Some scientists cling to the idea that the ‘best’ evidence should always catch the attention of policymakers, and assume that ‘speaking truth to power’ helps evidence win the day.

As such, researchers in fields like public health and climate change wonder why policymakers seem to ignore their evidence.

The truth is that policymakers only have the capacity to consider a tiny proportion of all available information. Therefore, they must find efficient ways to ignore almost all evidence to make timely choices.

They do so by setting goals and identifying trusted sources of evidence, but also using their gut instinct and beliefs to rule out most evidence as irrelevant to their aims.

Second, the UK government cannot ‘take back control’ of policy following Brexit simply because it was not in control of policy before the UK joined. The idea of control is built on the false image of a powerful centre of government led by a small number of elected policymakers.

This way of thinking assumes that sharing power is simply a choice. However, sharing power and responsibility is borne of necessity because the British state is too large to be manageable.

Governments manage this complexity by breaking down their responsibilities into many government departments. Still, ministers can only pay attention to a tiny proportion of issues managed by each department. They delegate most of their responsibilities to civil servants, agencies, and other parts of the public sector.

In turn, those organisations rely on interest groups and experts to provide information and advice.

As a result, most public policy is conducted through small and specialist ‘policy communities’ that operate out of the public spotlight and with minimal elected policymaker involvement.

The logical conclusion is that senior elected politicians are less important than people think. While we like to think of ministers sitting in Whitehall and taking crucial decisions, most of these decisions are taken in their name but without their intervention.

Third, the current pandemic underlines all too clearly the limits of government power. Of course people are pondering the degree to which we can blame UK government ministers for poor choices in relation to Covid-19, or learn from their mistakes to inform better policy.

Many focus on the extent to which ministers were ‘guided by the science’. However, at the onset of a new crisis, government scientists face the same uncertainty about the nature of the policy problem, and ministers are not really able to tell if a Covid-19 policy would work as intended or receive enough public support.

Some examples from the UK experience expose the limited extent to which policymakers can understand, far less control, an emerging crisis.

Prior to the lockdown, neither scientists nor ministers knew how many people were infected, nor when levels of infection would peak.

They had limited capacity to test. They did not know how often (and how well) people wash their hands. They did not expect people to accept and follow strict lockdown rules so readily, and did not know which combination of measures would have the biggest impact.

When supporting businesses and workers during ‘furlough’, they did not know who would be affected and therefore how much the scheme would cost.

In short, while Covid-19 has prompted policy change and state intervention on a scale not witnessed outside of wartime, the government has never really known what impact its measures would have.

Overall, the take-home message is that the UK narrative of strong central government control is damaging to political debate and undermines policy learning. It suggests that every poor outcome is simply the consequence of bad choices by powerful leaders. If so, we are unable to distinguish between the limited competence of some leaders and the limited powers of them all.

COVID-19 policy in the UK: SAGE Theme 3. Communicating to the public

This post is part 7 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

SAGE’s emphasis on uncertainty and limited knowledge extended to the evidence on how to influence behaviour via communication:

‘there is limited evidence on the best phrasing of messages, the barriers and stressors that people will encounter when trying to follow guidance, the attitudes of the public to the interventions, or the best strategies to promote adherence in the long-term’ (SPI-B Meeting paper 3.3.20: 2)

Early on, SAGE minutes described continuously the potential problems of communicating risk and encouraging behavioural change through communication (in other words, based on low expectations for the types of quarantine measures associated with China and South Korea).

• It sought ‘behavioural science input on public communication’ and ‘agreed on the importance of behavioural science informing policy – and on the importance of public trust in HMG’s approach’ (28.1.20: 2).
• It worried about how the public might interpret ‘case fatality rate’, given the different ways to describe and interpret frequencies and risks (4.2.20: 3).
• It stated that ‘Epidemiological terms need to be made clearer in the planning documents to avoid ambiguity’ (11.2.20: 3).
• Its extensive discussion of behavioural science (13.2.20: 2-3) includes: there will be public scepticism and inaction until first deaths are confirmed; the main aim is to motivate people by relating behavioural change to their lives; messaging should stress ‘personal responsibility and responsibility to others’ and be clear on which measures are effective’, and ‘National messaging should be clear and definitive: if such messaging is presented as both precautionary and sufficient, it will reduce the likelihood of the public adopting further unnecessary or contradictory behaviours’ (13.2.20: 2-3)
• Banning large public events could signal the need to change behaviour more generally, but evidence for its likely impact is unavailable (SPI-M-O, 11.2.20: 1).

Generally speaking, the assumption underpinning communication is that behavioural change will come largely from communication (encouragement and exhortation) rather than imposition. Hence, for example, the SPI-B (25.2.20: 2) recommendation on limiting the ‘risk of public disorder’:

• ‘Provide clear and transparent reasons for different strategies: The public need to understand the purpose of the Government’s policy, why the UK approach differs to other countries and how resources are being allocated. SPI-B agreed that government should prioritise messaging that explains clearly why certain actions are being taken, ahead of messaging designed solely for reassuring the public.
• This should also set clear expectations on how the response will develop, g. ensuring the public understands what they can expect as the outbreak evolves and what will happen when large numbers of people present at hospitals. The use of early messaging will help, as a) individuals are likely to be more receptive to messages before an issue becomes controversial and b) it will promote a sense the Government is following a plan.
• Promote a sense of collectivism: All messaging should reinforce a sense of community, that “we are all in this together.” This will avoid increasing tensions between different groups (including between responding agencies and the public); promote social norms around behaviours; and lead to self-policing within communities around important behaviours’.

The underpinning assumption is that the government should treat people as ‘rational actors’: explain risk and how to reduce it, support existing measures by the public to socially distance, be transparent, explain if UK is doing things differently to other countries, and recognise that these measures are easier for some more than others (13.3.20: 3).

In that context, SPI-B Meeting paper 22.3.20 describes how to enable social distancing with reference to the ‘behaviour change wheel’ (Michie et al, 2011): ‘There are nine broad ways of achieving behaviour change: Education, Persuasion, Incentivisation, Coercion, Enablement, Training, Restriction, Environmental restructuring, and Modelling’ and many could reinforce each other (22.3.20: 1). The paper comments on current policy in relation to 5 elements:

1. Education – clarify guidance (generally, and for shielding), e.g. through interactive website, tailored to many audiences
2. Persuasion – increase perceived threat among ‘those who are complacent, using hard-hitting emotional messaging’ while providing clarity and positive messaging (tailored to your audience’s motivation) on what action to take (22.3.20: 1-2).
3. Incentivisation – emphasise social approval as a reward for behaviour change
4. Coercion – ‘Consideration should be given to enacting legislation, with community involvement, to compel key social distancing measures’ (combined with encouraging ‘social disapproval but with a strong caveat around unwanted negative consequences’ (22.3.20: 2)
5. Enablement – make sure that people have alternative access to social contact, food, and other resources for people feeling the unequal impact of lockdown (particularly for vulnerable people shielding, aided by community support).

Apparently, section 3 of SPI-B’s meeting paper (1.4.20b: 2) had been redacted because it was critical of a UK Government ‘Framework; with 4 new proposals for greater compliance: ‘17) increasing the financial penalties imposed; 18) introducing self-validation for movements; 19) reducing exercise and/or shopping; 20) reducing non-home working’. On 17, it suggests that the evidence base for (e.g.) fining someone exercising more than 1km from their home could contribute to lower support for policy overall. On 17-19, it suggests that most people are already complying, so there is no evidence to support more targeted measures. It is more positive about 20, since it could reduce non-home working (especially if financially supported). Generally, it suggests that ministers should ‘also consider the role of rewards and facilitations in improving adherence’ and use organisational changes, such as staggered work hours and new use of space, rather than simply focusing on individuals.

Communication after the lockdown

SAGE suggests that communication problems are more complicated during the release of lockdown measures (in other words, without the ability to present the relatively-low-ambiguity message ‘stay at home’). Examples (mostly from SPI-B and its contributors) include:

• Address potential confusion, causing false concern or reassurance, regarding antigen and antibody tests (meeting papers 1.4.20c: 3; 13.4.20b: 1-4; 22.4.20b: 1-5; 29.4.20a: 1-4)
• When notifying people about the need to self-isolate, address the trade-offs between symptom versus positive test based notifications (meeting paper 29.4.20a: 1-4; 5.5.20: 1-8)
• If you are worried about public ‘disorder’, focus on clear, effective, tailored communication, using local influencers, appealing to sympathetic groups (like NHS staff), and co-producing messages between the police and public (in other words, police via consent, and do not exacerbate grievances) (meeting papers 19.4.20: 1-4; 21.4.20: 1-3; 4.5.20: 1-11)
• Be wary of lockdowns specific to very small areas, which undermine the ‘all in it together’ message (REDACTED and Clifford Stott, no date: 1). If you must to it, clarify precisely who is affected and what they should do, support the people most vulnerable and impacted (e.g. financially), and redesign physical spaces (meeting paper SPI-B 22.4.20a)
• When reopening schools (fully or partly), communication is key to the inevitably complex and unpredictable behavioural consequences (so, for example, work with parents, teachers, and other stakeholders to co-produce clear guidance) (29.4.20d: 1-10)
• On the introduction of Alert Levels, as part of the Joint Biosecurity Centre work on local outbreaks (described in meeting paper 20.5.20a: 1-9): build public trust and understanding regarding JBC alert levels, and relate them very clearly to expected behaviour (SAGE 28.5.20). Each Alert Level should relate clearly to a required response in that area, and ‘public communications on Alert Levels needs many trusted messengers giving the same advice, many times’ (meeting paper 27.5.20b: 3).
• On transmission between social networks, ‘Communicate two key principles: 1. People whose work involves large numbers of contacts with different people should avoid close, prolonged, indoor contact with anyone as far as possible … 2. People with different workplace networks should avoid meeting or sharing the same spaces’ (meeting paper 27.5.20b: 1).
• On outbreaks in ‘forgotten institutional settings’ (including Prisons, Homeless Hostels, Migrant dormitories, and Long stay mental health): address the unusually low levels of trust in (or awareness of) government messaging among so-called ‘hard to reach groups’ (meeting paper 28.5.20a: 1).

See also:

SPI-M (Meeting paper 17.3.20b: 4) list of how to describe probabilities. This is more important than it looks, since there is a potentially major gap between the public and advisory group understanding of words like ‘probably’ (compare with the CIA’s Words of Estimative Probability).

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

This post is part 6 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

Limited testing

Oral evidence to the Health and Social Care committee highlights the now-well-documented limits to UK testing capacity and PPE stocks (see also NERVTAG on PPE). SAGE does not discuss testing capacity much in the beginning, although on 10.3.20 it lists as an action point: ‘Plans for how PHE can move from 1,000 serology tests to 10,000 tests per week’ and by 16.3.20 it describes the urgent need to scale up testing – perhaps with commercial involvement and to test at home (if can ensure accuracy) – and to secure sufficient data to track the epidemic well enough to inform operational decisions. From April, it highlights the need for a ‘national testing strategy’ to cover NHS patients, staff, an epidemiological survey, and the community (2.4.20), and the need for far more testing is a feature of almost every meeting from then.

Limited contact tracing

Initially, SAGE describes a quite-low contact tracing capacity: ‘Currently, PHE can cope with five new cases a week (requiring isolation of 800 contacts). Modelling suggests this capacity could be increased to 50 new cases a week (8,000 contact isolations)’ (18.2.20: 1).

Previously, it had noted that the point would come when transmission was too high to make contact tracing worthwhile, particularly since many (e.g. asymptomatic) cases may already have been missed (20.2.20: 2) and the necessary testing capacity was not in place (16.4.20): ‘PHE to work with SPI-M to develop criteria for when contact tracing is no longer worthwhile. This should include consideration of any limiting factors on testing and alternative methods of identifying epidemic evolution and characteristics’ (11.2.20: 3; see also Testing and contact tracing).

It returned to the feasibility question after the lockdown, with:

• SPI-M (meeting paper 4.20d: 1-3) estimating that effective contact tracing (80% of non-household cases, in 2 days) could reduce the R by 30-60% if you could quarantine many people, multiple times; and,
• SPI-B (meeting paper 4.20a: 1-3) advising on the need to clarify to people how it would work and what they should do, redesign physical spaces, and conduct new qualitative research and stakeholder engagement to ‘help us to understand more clearly the specific drivers, enablers and barriers for new behavioural recommendations’ to address an unprecedented problem in the UK (22.4.20a: 2). SPI-B also describes the trade-offs between app-informed systems (notification based on symptoms would suit people seeking to be precautionary, but could reduce compliance among people who believe the risk to be low) (see meeting papers 29.4.20: 3 and 5.5.20: 1-8)
• SAGE noting ongoing work on clusters and super-spreading events, which necessitate cluster-based contact tracing (11.6.20: 3)
• A more general message that contact tracing will be overwhelmed if lockdown measures are released too soon, raising R well above 1 and causing incidence to rise too quickly (e.g. 14.5.20)

Low capacity to achieve high levels of information necessary for forecasting

This type of discussion exemplifies a general and continuous focus on the lack of data to inform advice:

‘24. Real-time forecasting models rely on deriving information on the epidemic from surveillance. If transmission is established in the UK there will necessarily be a delay before sufficiently accurate forecasts in the UK are available. 25. Decisions being made on whether to modify or lift non-pharmaceutical interventions require accurate understanding of the state of the epidemic. Large-scale serological data would be ideal, especially combined with direct monitoring of contact behaviour. 26. Preliminary forecasts and accurate estimates of epidemiological parameters will likely be available in the order of weeks and not days following widespread outbreaks in the UK (or a similar country). While some estimates may be available before this time their accuracy will be much more limited. 27. The UK hospitalisation rate and CFR will be very important for operational planning and will be estimated over a similar timeframe. They may take longer depending on the availability of data’ (Meeting paper 2.3.20: 3-4).

A limited capacity to reach a relatively cautious consensus?

These limitations to information contributed to the difference between SAGE’s estimate on UK transmission (such as in comparison with Italy) and the UK’s much faster rate of transmission:

‘the UK likely has thousands of cases – as many as 5,000 to 10,000 – which are geographically spread nationally … The UK is considered to be 4-5 weeks behind Italy but on a similar curve (6-8 weeks behind if interventions are applied)’ (10.3.20: 1)

‘Based on limited available evidence, SAGE considers that the UK is 2 to 4 weeks behind Italy in terms of the epidemic curve’ (18.3.20: 1)

Rather, the UK was under 2 weeks behind Italy on the 10^th March, suggesting that its lockdown measures were put in place too late.

At the heart of this estimate was the under-estimated doubling time of infection (‘the time it takes for the number of cases to double in size’, Meeting paper 3.2.20a):

• although described as 3-4 days (28.1.20: 1) then 4-6 days (Meeting paper 2.3.20) based on Wuhan, and 3-5 days based on Hubei (Meeting paper 3.2.20a),
• SAGE estimates ‘every 5-6 days’ (16.3.20: 1) and states that ‘Assuming a doubling time of around 5-7 days continues to be reasonable’ (18.3.20: 1).
• Only by meeting 18 does SAGE estimate the doubling time (ICU patients) at 3-4 days (23.3.20). By meeting 19, it describes the doubling time in hospitals as 3.3 days (26.3.20: 1).

Kit Yates suggests that (a) the UK exhibited a 3-day doubling time during this period (Huffington Post), and (b) although many members of SAGE and SPI-M would have preferred to model on the assumption of 3-days:

Having spoken to some of the modellers on SPI-M, not all of them were missing this. Many of the groups had fitted models to data and come up with shorter and more realistic doubling times, maybe around the 3-day mark, but their estimates never found consensus within the group, so some members of SPI-M have communicated their concerns to me that some of the modelling groups had more influence over the consensus decision than others, which meant that some opinions or estimates which might have been valid, didn’t get heard, and consequently weren’t passed on up the line to SAGE, and then further towards the government, so an over-reliance on certain models or modelling groups might have been costly in this situation (interview, Kit Yates, More or Less, 10.6.20: 4m47s-5m27s)

Yates then suggests that the most listened-to model – led by Neil Ferguson, published 16.3.20 –  estimates a doubling time of 5-days, based on early data from Wuhan, using estimate of R2.4 (and generation time of 6.5 days), ‘which we now know to be way too low’ when we look at the UK data:

‘If they had just plotted the early trajectory of the epidemics against the current UK data at that point, they would have seen [by 14.3.20] that their model was starting to underestimate the number of cases and then the number of deaths which were occurring in the UK’ (interview, Kit Yates, More or Less, 10.6.20: 7m2s-7m15s)

Yates’ account highlights not only

1. the effect of uncertainty and limited capacity to generate more information, but also
2. the wider effect of path dependence, in which the (a) written and unwritten rules and norms of organisations, and (b) enduring ways of thinking (in individuals and groups, and political systems) place limits on new action. These limits are often necessary and beneficial, and often unnecessary and harmful.

Compare with Vallance’s oral evidence to the Health and Social Care committee (17.3.20: q96):

‘If you thought SAGE and the way SAGE works was a cosy consensus of agreeing scientists, you would be very mistaken. It is a lively, robust discussion, with multiple inputs. We do not try to get everybody saying exactly the same thing’.

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: SAGE Theme 1. The language of intervention

This post is part 5 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

There is often a clear distinction between a strategy designed to (a) eliminate a virus/ the spread of disease quickly, and (b) manage the spread of infection over the long term (see The overall narrative).

However, generally, the language of virus management is confusing. We need to be careful with interpreting the language used in these minutes, and other sources such as oral evidence to House of Commons committees, particularly when comparing the language at the beginning (when people were also unsure what to call SARS-CoV-2 and COVID-19) to present day debates.

For example, in January, it is tempting to contrast ‘slow down the spread of the outbreak domestically’ (28.1.20: 2) with a strategy towards ‘extinction’, but the proposed actions may be the same even if the expectations of impact are different. Some people interpret these differences as indicative of a profoundly different approach (delay versus eradicate); some describe the semantic differences as semantics.

By February, SAGE’s expectation is of an inevitable epidemic and inability to contain COVID-19, prompting it to describe the inevitable series of stages:

‘Priorities will shift during a potential outbreak from containment and isolation on to delay and, finally, to case management … When there is sustained transmission in the UK, contact tracing will no longer be useful’ (18.2.20: 1; its discussion on 20.2.20: 2 also concludes that ‘individual cases could already have been missed – including individuals advised that they are not infectious’).

Mitigation versus suppression

On the face of it, it looks like there is a major difference in the ways on which (a) the Imperial College COVID-19 Response Team and (b) SAGE describe possible policy responses. The Imperial paper makes a distinction between mitigation and suppression:

1. Its ‘mitigation strategy scenarios’ highlight the relative effects of partly-voluntary measures on mortality and demand for ‘critical care beds’ in hospitals: (voluntary) ‘case isolation in the home’ (people with symptoms stay at home for 7 days), ‘voluntary home quarantine’ (all members of the household stay at home for 14 days if one member has symptoms), (government enforced) ‘social distancing of those over 70’ or ‘social distancing of entire population’ (while still going to work, school or University), and closure of most schools and universities. It omits ‘stopping mass gatherings’ because ‘the contact-time at such events is relatively small compared to the time spent at home, in schools or workplaces and in other community locations such as bars and restaurants’ (2020a: 8). Assuming 70-75% compliance, it describes the combination of ‘case isolation, home quarantine and social distancing of those aged over 70’ as the most impactful, but predicts that ‘mitigation is unlikely to be a viable option without overwhelming healthcare systems’ (2020a: 8-10). These measures would only ‘reduce peak critical care demand by two-thirds and halve the number of deaths’ (to approximately 250,000).
2. Its ‘suppression strategy scenarios’ describe what it would take to reduce the rate of infection (R) from the estimated 2.0-2.6 to 1 or below (in other words, the game-changing point at which one person would infect no more than one other person) and reduce ‘critical care requirements’ to manageable levels. It predicts that a combination of four options – ‘case isolation’, ‘social distancing of the entire population’ (the measure with the largest impact), ‘household quarantine’ and ‘school and university closure’ – would reduce critical care demand from its peak ‘approximately 3 weeks after the interventions are introduced’, and contribute to a range of 5,600-48,000 deaths over two years (depending on the current R and the ‘trigger’ for action in relation to the number of occupied critical care beds) (2020a: 13-14).

In comparison, the SAGE meeting paper (26.2.20b: 1-3), produced 2-3 weeks earlier, pretty much assumes away the possible distinction between mitigation versus suppression measures (which Vallance has described as semantic rather than substantive – scroll down to The distinction between mitigation and suppression measures). In other words, it assumes ‘high levels of compliance over long periods of time’ (26.2.20b: 1). As such, we can interpret SAGE’s discussion as (a) requiring high levels of compliance for these measures to work (the equivalent of Imperial’s description of suppression), while (b) not describing how to use (more or less voluntary versus impositional) government policy to secure compliance. In comparison, Imperial equates suppression with the relatively-short-term measures associated with China and South Korea (while noting uncertainty about how to maintain such measures until a vaccine is produced).

It is taking forever, but I think I am now managing to get into the rhythm of the February SAGE minutes (in relation to media interviews and oral evidence in March), at least enough to identify the need to interpret the text in a relatively thoughtful/ sympathetic way ….

— Professor Paul Cairney (@CairneyPaul) June 29, 2020

One reason for SAGE to assume compliance in its scenario building is to focus on the contribution of each measure, generally taking place over 13 weeks, to delaying the peak of infection (while stating that ‘It will likely not be feasible to provide estimates of the effectiveness of individual control measures, just the overall effectiveness of them all’, 26.2.20b: 1), while taking into account their behavioural implications (26.2.20b: 2-3).

• School closures could contribute to a 3-week delay, especially if combined with FE/ HE closures (but with an unequal impact on ‘Those in lower socio-economic groups … more reliant on free school meals or unable to rearrange work to provide childcare’).
• Home isolation (65% of symptomatic cases stay at home for 7 days) could contribute to a 2-3 week delay (and is the ‘Easiest measure to explain and justify to the public’).
• ‘Voluntary household quarantine’ (all member of the household isolate for 14 days) would have a similar effect – assuming 50% compliance – but with far more implications for behavioural public policy:

‘Resistance & non-compliance will be greater if impacts of this policy are inequitable. For those on low incomes, loss of income means inability to pay for food, heating, lighting, internet. This can be addressed by guaranteeing supplies during quarantine periods.

Variable compliance, due to variable capacity to comply, may lead to dissatisfaction.

Ensuring supplies flow to households is essential. A desire to help among the wider community (e.g. taking on chores, delivering supplies) could be encouraged and scaffolded to support quarantined households.

There is a risk of stigma, so ‘voluntary quarantine’ should be portrayed as an act of altruistic civic duty’.

• ‘Social distancing’ (‘enacted early’), in which people restrict themselves to essential activity (work and school) could produce a 3-5 week delay (and likely to be supported in relation to mass leisure events, albeit less so when work activities involve a lot of contact.

[Note that it is not until May that it addresses this issue of feasibility directly (and, even then, it does not distinguish between technical and political feasibility: ‘It was noted that a useful addition to control measures SAGE considers (in addition to scientific uncertainty) would be the feasibility of monitoring/ enforcement’ (7.5.20: 3)]

As theme 2 suggests, there is a growing recognition that these measures should have been introduced by early March (such as via the Coronavirus Act 2020 not passed until 25.3.20), and likely would if the UK government and SAGE had more information (or interpreted its information in a different way). However, by mid-March, SAGE expresses a mixture of (a) growing urgency, but also (b) the need to stick to the plan, to reduce the peak and avoid a second peak of infection). On 13^th March, it states:

‘There are no strong scientific grounds to hasten or delay implementation of either household isolation or social distancing of the elderly or the vulnerable in order to manage the epidemiological curve compared to previous advice. However, there will be some minor gains from going early and potentially useful reinforcement of the importance of taking personal action if symptomatic. Household isolation is modelled to have the biggest effect of the three interventions currently planned, but with some risks. SAGE therefore thinks there is scientific evidence to support household isolation being implemented as soon as practically possible’ (13.3.20: 1)

‘SAGE further agreed that one purpose of behavioural and social interventions is to enable the NHS to meet demand and therefore reduce indirect mortality and morbidity. There is a risk that current proposed measures (individual and household isolation and social distancing) will not reduce demand enough: they may need to be coupled with more intensive actions to enable the NHS to cope, whether regionally or nationally’ (13.3.20: 2)

On 16^th March, it states:

‘On the basis of accumulating data, including on NHS critical care capacity, the advice from SAGE has changed regarding the speed of implementation of additional interventions. SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible’ (16.3.20: 1)

Overall, we can conclude two things about the language of intervention:

1. There is now a clear difference between the ways in which SAGE and its critics describe policy: to manage an inevitably long-term epidemic, versus to try to eliminate it within national borders.
2. There is a less clear difference between terms such as suppress and mitigate, largely because SAGE focused primarily on a comparison of different measures (and their combination) rather than the question of compliance.

See also: There is no ‘herd immunity strategy’, which argues that this focus on each intervention was lost in radio and TV interviews with Vallance.

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: SAGE meetings from January-June 2020

This post is part 4 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings

SAGE began a series of extraordinary meetings from 22nd January 2020. The first was described as ‘precautionary’ (22.1.20: 1) and includes updates from NERVTAG which met from 13^th January. Its minutes state that ‘SAGE is unable to say at this stage whether it might be required to reconvene’ (22.1.20: 2). The second meeting notes that SAGE will meet regularly (e.g. 2-3 times per week in February) and coordinate all relevant science advice to inform domestic policy, including from NERVTAG and SPI-M (Scientific Pandemic Influenza Group on Modelling) which became a ‘formal sub-group of SAGE for the duration of this outbreak’ (SPI-M-O) (28.1.20: 1). It also convened an additional Scientific Pandemic Influenza subgroup (SPI-B) in February. I summarise these developments by month, but you can see that, by March, it is worth summarising each meeting. The main theme is uncertainty.

January 2020

The first meeting highlights immense uncertainty. Its description of WN-CoV (Wuhan Coronavirus), and statements such as ‘There is evidence of person-to-person transmission. It is unknown whether transmission is sustainable’, sum up the profound lack of information on what is to come (22.1.20: 1-2). It notes high uncertainty on how to identify cases, rates of infection, infectiousness in the absence of symptoms, and which previous experience (such as MERS) offers the most useful guidance. Only 6 days later, it estimates an R between 2-3, doubling rate of 3-4 days, incubation period of around 5 days, 14-day window of infectivity, varied symptoms such as coughing and fever, and a respiratory transmission route (different from SARS and MERS) (28.1.20: 1). These estimates are fairly constant from then, albeit qualified with reference to uncertainty (e.g. about asymptomatic transmission), some key outliers (e.g. the duration of illness in one case was 41 days – 4.2.20: 1), and some new estimates (e.g. of a 6-day ‘serial interval’, or ‘time between successive cases in a chain of transmission’, 11.2.20: 1). By now, it is preparing a response: modelling a ‘reasonable worst case scenario’ (RWC) based on the assumption of an R of 2.5 and no known treatment or vaccine, considering how to slow the spread, and considering how behavioural insights can be used to encourage self-isolation.

February 2020

SAGE began to focus on what measures might delay or reduce the impact of the epidemic. It described travel restrictions from China as low value, since a 95% reduction would have to be draconian to achieve and only secure a one month delay, which might be better achieved with other measures (3.2.20: 1-2). It, and supporting papers, suggested that the evidence was so limited that they could draw ‘no meaningful conclusions … as to whether it is possible to achieve a delay of a month’ by using one or a combination of these measures: international travel restrictions, domestic travel restrictions, quarantine people coming from infected areas, close schools, close FE/ HE, cancel large public events, contact tracing, voluntary home isolation, facemasks, hand washing. Further, some could undermine each other (e.g. school closures impact on older people or people in self-isolation) and have major societal or opportunity costs (SPI-M-O, 3.2.20b: 1-4). For example, the ‘SPI-M-O: Consensus view on public gatherings’ (11.2.20: 1) notes the aim to reduce duration and closeness of (particularly indoor) contact. Large outdoor gatherings are not worse than small, and stopping large events could prompt people to go to pubs (worse).

Throughout February, the minutes emphasize high uncertainty:

• if there will be an epidemic outside of China (4.2.20: 2)
• if it spreads through ‘air conditioning systems’ (4.2.20: 3)
• the spread from, and impact on, children and therefore the impact of closing schools (4.2.20: 3; discussed in a separate paper by SPI-M-O, 10.2.20c: 1-2)
• ‘SAGE heard that NERVTAG advises that there is limited to no evidence of the benefits of the general public wearing facemasks as a preventative measure’ (while ‘symptomatic people should be encouraged to wear a surgical face mask, providing that it can be tolerated’ (4.2.20: 3)

At the same time, its meeting papers emphasized a delay in accurate figures during an initial outbreak: ‘Preliminary forecasts and accurate estimates of epidemiological parameters will likely be available in the order of weeks and not days following widespread outbreaks in the UK’ (SPI-M-O, 3.2.20a: 3).

This problem proved to be crucial to the timing of government intervention. A key learning point will be the disconnect between the following statement and the subsequent realisation (3-4 weeks later) that the lockdown measures from mid-to-late March came too late to prevent an unanticipated number of excess deaths:

‘SAGE advises that surveillance measures, which commenced this week, will provide

actionable data to inform HMG efforts to contain and mitigate spread of Covid-19’ … PHE’s surveillance approach provides sufficient sensitivity to detect an outbreak in its early stages. This should provide evidence of an epidemic around 9- 11 weeks before its peak … increasing surveillance coverage beyond the current approach would not significantly improve our understanding of incidence’ (25.2.20: 1)

It also seems clear from the minutes and papers that SAGE highlighted a reasonable worst case scenario on 26.2.20. It was as worrying as the Imperial College COVID-19 Response Team report dated 16.3.20 that allegedly changed the UK Government’s mind on the 16^th March. Meeting paper 26.2.20a described the assumption of an 80% infection attack rate and 50% clinical attack rate (i.e. 50% of the UK population would experience symptoms), which underpins the assumption of 3.6 million requiring hospital care of at least 8 days (11% of symptomatic), and 541,200 requiring ventilation (1.65% of symptomatic) for 16 days. While it lists excess deaths as unknown, its 1% infection mortality rate suggests 524,800 deaths. This RWC replaces a previous projection (in Meeting paper 10.2.20a: 1-3, based on pandemic flu assumptions) of 820,000 excess deaths (27.2.20: 1).

As such, the more important difference could come from SAGE’s discussion of ‘non-pharmaceutical interventions (NPIs)’ if it recommends ‘mitigation’ while the Imperial team recommends ‘suppression’. However, the language to describe each approach is too unclear to tell (see Theme 1. The language of intervention; also note that NPIs were often described from March as ‘behavioural and social interventions’ following an SPI-B recommendation, Meeting paper 3.2.20: 1, but the language of NPI seems to have stuck).

March 2020

In March, SAGE focused initially (Meetings 12-14) on preparing for the peak of infection on the assumption that it had time to transition towards a series of isolation and social distancing measures that would be sustainable (and therefore unlikely to contribute to a second peak if lifted too soon). Early meetings and meeting papers express caution about the limited evidence for intervention and the potential for their unintended consequences. This approach began to change somewhat from mid-March (Meeting 15), and accelerate from Meetings 16-18, when it became clear that incidence and virus transmission were much larger than expected, before a new phase began from Meeting 19 (after the UK lockdown was announced on the 23^rd).

Meeting 12 (3.3.18) describes preparations to gather and consolidate information on the epidemic and the likely relative effect of each intervention, while its meeting papers emphasise:

• ‘It is highly likely that there is sustained transmission of COVID-19 in the UK at present’, and a peak of infection ‘might be expected approximately 3-5 months after the establishment of widespread sustained transmission’ (SPI-M Meeting paper 2.3.20: 1)
• the need the prepare the public while giving ‘clear and transparent reasons for different strategies’ and reducing ambiguity whenever giving guidance (SPI-B Meeting paper 3.2.20: 1-2)
• The need to combine different measures (e.g. school closure, self-isolation, household isolation, isolating over-65s) at the right time; ‘implementing a subset of measures would be ideal. Whilst this would have a more moderate impact it would be much less likely to result in a second wave’ (Meeting paper 4.3.20a: 3).

Meeting 13 (5.3.20) describes staying in the ‘containment’ phase (which, I think, means isolating people with positive tests at home or in hospital) , and introducing: a 12-week period of individual and household isolation measures in 1-2 weeks, on the assumption of 50% compliance; and a longer period of shielding over-65s 2 weeks later. It describes ‘no evidence to suggest that banning very large gatherings would reduce transmission’, while closing bars and restaurants ‘would have an effect, but would be very difficult to implement’, and ‘school closures would have smaller effects on the epidemic curve than other options’ (5.3.20: 1). Its SPI-B Meeting paper (4.3.20b) expresses caution about limited evidence and reliance on expert opinion, while identifying:

• potential displacement problems (e.g. school closures prompt people to congregate elsewhere, or be looked after by vulnerable older people, while parents to lose the chance to work)
• the visibility of groups not complying
• the unequal impact on poorer and single parent families of school closure and loss of school meals, lost income, lower internet access, and isolation
• how to reduce discontent about only isolating at-risk groups (the view that ‘explaining that members of the community are building some immunity will make this acceptable’ is not unanimous) (4.3.20b: 2).

Meeting 14 (10.3.20) states that the UK may have 5-10000 cases and ‘10-14 weeks from the epidemic peak if no mitigations are introduced’ (10.3.20: 2). It restates the focus on isolation first, followed by additional measures in April, and emphasizes the need to transition to measures that are acceptable and sustainable for the long term:

‘SAGE agreed that a balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods’ …’the public will face considerable challenges in seeking to comply with these measures, (e.g. poorer households, those relying on grandparents for childcare)’ (10.3.20: 2)

Meeting 15 (13.3.20: 1) describes an update to its data, suggesting ‘more cases in the UK than SAGE previously expected at this point, and we may therefore be further ahead on the epidemic curve, but the UK remains on broadly the same epidemic trajectory and time to peak’. It states that ‘household isolation and social distancing of the elderly and vulnerable should be implemented soon, provided they can be done well and equitably’, noting that there are ‘no strong scientific grounds’ to accelerate key measures but ‘there will be some minor gains from going early and potentially useful reinforcement of the importance of taking personal action if symptomatic’ (13.3.20: 1) and ‘more intensive actions’ will be required to maintain NHS capacity (13.3.20: 2).

*******

On the 16^th March, the UK Prime Minister Boris Johnson describes an ‘emergency’ (one week before declaring a ‘national emergency’ and UK-wide lockdown)

*******

Meeting 16 (16.3.20) describes the possibility that there are 5-10000 new cases in the UK (there is great uncertainty on the estimate’), doubling every 5-6 days. Therefore, to stay within NHS capacity, ‘the advice from SAGE has changed regarding the speed of implementation of additional interventions. SAGE advises that there is clear evidence to support additional social distancing measures be introduced as soon as possible’ (16.3.20: 1). SPI-M Meeting paper (16.3.20: 1) describes:

‘a combination of case isolation, household isolation and social distancing of vulnerable groups is very unlikely to prevent critical care facilities being overwhelmed … it is unclear whether or not the addition of general social distancing measures to case isolation, household isolation and social distancing of vulnerable groups would curtail the epidemic by reducing the reproduction number to less than 1 … the addition of both general social distancing and school closures to case isolation, household isolation and social distancing of vulnerable groups would be likely to control the epidemic when kept in place for a long period. SPI-M-O agreed that this strategy should be followed as soon as practical’

Meeting 17 (18.3.20) marks a major acceleration of plans, and a de-emphasis of the low-certainty/ beware-the-unintended-consequences approach of previous meetings (on the assumption that it was now 2-4 weeks behind Italy). It recommends school closures as soon as possible (and it, and SPIM Meeting paper 17.3.20b, now downplays the likely displacement effect). It focuses particularly on London, as the place with the largest initial numbers:

‘Measures with the strongest support, in terms of effect, were closure of a) schools, b) places of leisure (restaurants, bars, entertainment and indoor public spaces) and c) indoor workplaces. … Transport measures such as restricting public transport, taxis and private hire facilities would have minimal impact on reducing transmission’ (18.3.20: 2)

Meeting 18 (23.3.20) states that the R is higher than expected (2.6-2.8), requiring ‘high rates of compliance for social distancing’ to get it below 1 and stay under NHS capacity (23.3.20: 1). There is an urgent need for more community testing/ surveillance (and to address the global shortage of test supplies). In the meantime, it needs a ‘clear rationale for prioritising testing for patients and health workers’ (the latter ‘should take priority’) (23.3.20: 3) Closing UK borders ‘would have a negligible effect on spread’ (23.3.20: 2).

*******

The lockdown. On the 23^rd March 2020, the UK Prime Minister Boris Johnson declared: ‘From this evening I must give the British people a very simple instruction – you must stay at home’. He announced measures to help limit the impact of coronavirus, including police powers to support public health, such as to disperse gatherings of more than two people (unless they live together), close events and shops, and limit outdoor exercise to once per day (at a distance of two metres from others).

*******

Meeting 19 (26.3.20) follows the lockdown. SAGE describes its priorities if the R goes below 1 and NHS capacity remains under 100%: ‘monitoring, maintenance and release’ (based on higher testing); public messaging on mass testing and varying interventions; understanding nosocomial transmission and immunology; clinical trials (avoiding hasty decisions’ on new drug treatment in absence of good data) and ‘how to minimise potential harms from the interventions, including those arising from postponement of normal services, mental ill health and reduced ability to exercise. It needs to consider in particular health impacts on poorer people’ (26.3.20: 1-2). The optimistic scenario is 10,000 deaths from the first wave (SPIM-O Meeting paper 25.3.20: 4).

Meeting 20 Confirms RWC and optimistic scenarios (Meeting paper 25.3.20), but it needs a ‘clearer narrative, clarifying areas subject to uncertainty and sensitivities’ and to clarify that scenarios (with different assumptions on, for example, the R, which should be explained more) are not predictions (29.3.20).

Meeting 21 seeks to establish SAGE ‘scientific priorities’ (e.g. long term health impacts of COVID-19, including socioeconomic impact on health (including mental health), community testing, international work (‘comorbidities such as malaria and malnutrition) (31.3.20: 1-2). NHS to set up an interdisciplinary group (including science and engineering) to ‘understand and tackle nosocomial transmission’ in the context of its growth and urgent need to define/ track it (31.3.20: 1-2). SAGE to focus on testing requirements, not operational issues. It notes the need to identify a single source of information on deaths.

April 2020

The meetings in April highlight four recurring themes.

First, it stresses that it will not know the impact of lockdown measures for some time, that it is too soon to understand the impact of releasing them, and there is high risk of failure: ‘There is a danger that lifting measures too early could cause a second wave of exponential epidemic growth – requiring measures to be re-imposed’ (2.4.20: 1; see also 14.4.20: 1-2). This problem remains even if a reliable testing and contact tracing system is in place, and if there are environmental improvements to reduce transmission (by keeping people apart).

Second, it notes signals from multiple sources (including CO-CIN and the RCGP) on the higher risk of major illness and death among black people, the ongoing investigation of higher risk to ‘BAME’ health workers (16.4.20), and further (high priority) work on ‘ethnicity, deprivation, and mortality’ (21.4.20: 1) (see also: Race, ethnicity, and the social determinants of health).

Third, it highlights the need for a ‘national testing strategy’ to cover NHS patients, staff, an epidemiological survey, and the community (2.4.20). The need for far more testing is a feature of almost every meeting (see also The need to ramp up testing).

Fourth, SAGE describes the need for more short and long-term research, identifying nosocomial infection as a short term priority, and long term priorities in areas such as the long term health impacts of COVID-19 (including socioeconomic impacts on physical and mental health), community testing, and international work (31.3.20: 1-2).

Finally, it reflects shifting advice on the precautionary use of face masks. Previously, advisory bodies emphasized limited evidence of a clear benefit to the wearer, and worried that public mask use would reduce the supply to healthcare professionals and generate a false sense of security (compare with this Greenhalgh et al article on the precautionary principle, the subsequent debate, and work by the Royal Society). Even by April: ‘NERVTAG concluded that the increased use of masks would have minimal effect’ on general population infection (7.4.20: 1), while the WHO described limited evidence that facemasks are beneficial for community use (9.4.20). Still, general face mask use but could have small positive effect, particularly in ‘enclosed environments with poor ventilation, and around vulnerable people’ (14.4.20: 2) and ‘on balance, there is enough evidence to support recommendation of community use of cloth face masks, for short periods in enclosed spaces where social distancing is not possible’ (partly because people can be infectious with no symptoms), as long as people know that it is no substitute for social distancing and handwashing (21.4.20)

May 2020

In May, SAGE continues to discuss high uncertainty on relaxing lockdown measures, the details of testing systems, and the need for research.

Generally, it advises that relaxations should not happen before there is more understanding of transmission in hospitals and care homes, and ‘until effective outbreak surveillance and test and trace systems are up and running’ (14.5.20). It advises specifically ‘against reopening personal care services, as they typically rely on highly connected workers who may accelerate transmission’ (5.5.20: 3) and warns against the too-quick introduction of social bubbles. Relaxation runs the risk of diminishing public adherence to social distancing, and to overwhelm any contact tracing system put in place:

‘SAGE participants reaffirmed their recent advice that numbers of Covid-19 cases remain high (around 10,000 cases per day with wide confidence intervals); that R is 0.7-0.9 and could be very close to 1 in places across the UK; and that there is very little room for manoeuvre especially before a test, trace and isolate system is up and running effectively. It is not yet possible to assess the effect of the first set of changes which were made on easing restrictions to lockdown’ (28.5.20: 3).

It recommends extensive testing in hospitals and care homes (12.5.20: 3) and ‘remains of the view that a monitoring and test, trace & isolate system needs to be put in place’ (12.5.20: 1)

June 2020

In June, SAGE identifies the importance of clusters of infection (super-spreading events) and the importance of a contact tracing system that focuses on clusters (rather than simply individuals) (11.6.20: 3). It reaffirms the value of a 2-metre distance rule. It also notes that the research on immunology remains unclear, which makes immunity passports a bad idea (4.6.20).

It describes the result of multiple meeting papers on the unequal impact of COVID-19:

‘There is an increased risk from Covid-19 to BAME groups, which should be urgently investigated through social science research and biomedical research, and mitigated by policy makers’ … ‘SAGE also noted the importance of involving BAME groups in framing research questions, participating in research projects, sharing findings and implementing recommendations’ (4.6.20: 1-3)

See also: Race, ethnicity, and the social determinants of health

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

COVID-19 policy in the UK: The overall narrative underpinning SAGE advice and UK government policy

This post is part 3 of COVID-19 policy in the UK: Did the UK Government ‘follow the science’? Reflections on SAGE meetings (update: see the notes on Dominic Cummings’ tweets at the end)

I discuss the UK government’s definition of the COVID-19 policy problem in some other posts (1. in a now-dated post on early developments, and 2. in relation to oral evidence to the Health and Social Care committee). It includes the following elements:

• We need to use a suppression strategy to reduce infection enough to avoid overwhelming health service capacity, and shield the people most vulnerable to major illness or death caused by COVID-19, to minimize deaths during at least one peak of infection.
• We need to maintain suppression for a period of time that is difficult to predict, subject to compliance levels that are difficult to predict and monitor.
• We need to avoid panicking the public in the lead up to suppression, avoid too-draconian enforcement, and maintain wide public trust in the government.
• We need to avoid (a) excessive and (b) insufficient suppression measures, either of which could contribute to a second wave of the epidemic of the same magnitude as the first.
• We need to transition safely from suppression measures to foster economic activity, find safe ways for people to return to work and education, and reinstate the full use of NHS capacity for non-COVID-19 illness.
• In the absence of a vaccine, this strategy will likely involve social distancing and (voluntary) track-and-trace measures to isolate people with COVID-19.

This understanding in the UK, informed strongly by SAGE, also informs the ways in which SAGE (a) deals with uncertainty, and (b) describes the likely impact of each stage of action.

Manage suppression during the first peak to avoid a second peak

Most importantly, it stresses continuously the need to avoid excessive suppressive measures on the first peak that would contribute to a second peak [my emphasis added]:

• ‘Any combination of [non-pharmaceutical] measures would slow but not halt an epidemic’, 25.2.20: 1).
• ‘Mitigations can be expected to change the shape of the epidemic curve or the timing of a first or second peak, but are not likely to reduce the overall number of total infections’. Therefore, identify whose priorities matter (such as NHS England) on the assumption that, ‘The optimal shape of the epidemic curve will differ according to sectoral or organisational priorities’ (27.2.20: 2).
• ‘A combination of these measures [school closures, household isolation, social distancing] is expected to have a greater impact: implementing a subset of measures would be ideal. Whilst this would have a more moderate impact it would be much less likely to result in a second wave. In comparison combining stringent social distancing measures, school closures and quarantining cases, as a long-term policy, may have a similar impact to that seen in Hong Kong or Singapore, but this could result in a large second epidemic wave once the measures were lifted’ (Meeting paper 4.3.20a: 3).
• ‘SAGE was unanimous that measures seeking to completely suppress spread of Covid-19 will cause a second peak. SAGE advises that it is a near certainty that countries such as China, where heavy suppression is underway, will experience a second peak once measures are relaxed’ (also: ‘It was noted that Singapore had had an effective “contain phase” but that now new cases had appeared) (13.3.20: 2)
• Its visual of each possible peak of infection emphasises the risk of a second peak (Meeting paper 4.3.20: 2).

• ‘The objective is to avoid critical cases exceeding NHS intensive care and other respiratory support bed capacity’ … SAGE ‘advice on interventions should be based on what the NHS needs’ (16.3.20: 1)
• The fewer cases that happen as a result of the policies enacted, the larger subsequent waves are expected to be when policies are lifted (SPI-M-O Meeting paper 25.3.20: 1)
• ‘There is a danger that lifting measures too early could cause a second wave of exponential epidemic growth – requiring measures to be re-imposed’ (2.4.20: 1)

Avoid the unintended consequences of epidemic suppression

This understanding intersects with (c) an emphasis of the loss of benefits caused by certain interventions (such as schools closures).

• SPI-B (Meeting paper 4.3.20b: 1-4) expresses reluctance to close schools, partly to avoid the unintended consequences, including: displacement problems (e.g. school closures prompt children to be looked after by vulnerable older people, or parents to lose the chance to work); and, the unequal impact on poorer and single parent families (loss of school meals, lost income, lower internet access, exacerbating isolation and mental ill health). It then states that: ‘The importance of schools during a crisis should not be overlooked. This includes: Acting as a source of emotional support for children; Providing education (e.g. on hand hygiene) which is conveyed back to families; Provision of social service (e.g. free school meals, monitoring wellbeing); Acting as a point of leadership and communication within communities’ (4.3.20b: 4).
• ‘Long periods of social isolation may have significant risks for vulnerable people … SAGE agreed that a balance needs to be struck between interventions that theoretically have significant impacts and interventions which the public can feasibly and safely adopt in sufficient numbers over long periods. Input from behavioural scientists is essential to policy development of cocooning measures, to increase public practicability and likelihood of compliance … the public will face considerable challenges in seeking to comply with these measures, (e.g. poorer households, those relying on grandparents for childcare)’ (10.3.20: 2).
• After the lockdown (23.3.20), SAGE describes a priority regarding: ‘how to minimise potential harms from the interventions, including those arising from postponement of normal services, mental ill health and reduced ability to exercise. It needs to consider in particular health impacts on poorer people’ (26.3.20: 1-2).

Exhort and encourage, rather than impose

It also intersects with (d) a primary focus on exhortation and encouragement rather than the imposition of behavioural change (Table 1), largely based on the belief that the UK government would be unwilling or unable to enforce behavioural change in ways associated with China. In that context, the government’s willingness and ability to enforce social distancing and business closure from the 23^rd March is striking.

Examples include:

• when recommending ‘individual home isolation (symptomatic individuals to stay at home for 14 days) and whole family isolation (fellow household members of symptomatic individuals to stay at home for 14 days after last family member becomes unwell)’, it assumes a 50% compliance rate, and notes that ‘closing bars and restaurants ‘would have an effect, but would be very difficult to implement’ (5.3.20: 1).

See also: oral evidence to the Health and Social Care committee, which suggests that the UK government and SAGE’s problem definition contrasts with approaches in countries such as South Korea (described by Kim et al, and Kim).

It also contrasts with the approach described by several of the UK’s (expert) critics, including Professor Devi Sridhar (Professor of Global Public Health), who is critical of SAGE specifically, and more generally of the UK government’s rejection of an ‘elimination’ strategy:

Eradication -> getting rid of every case of COVID on the planet. Only possible in long-term w/vaccine.

Elimination -> moving towards 0 infections within national borders. Yes, imported cases will occur, but if identified quickly, can mean return to largely ‘normal’ daily life.

— Prof. Devi Sridhar (@devisridhar) June 22, 2020

We need a concerted push across the 4 nations for elimination. Here is how New Zealand did it & why it's feasible over the summer with political will, leadership & public willingness to comply. Only way to get back to 'normal' life. https://t.co/7BXf5gZJjz https://t.co/Qk7PM13XrO

— Prof. Devi Sridhar (@devisridhar) June 14, 2020

Too much short-sightedness & focus on 2 weeks ahead instead of 6-8 months ahead. Same issue back in Jan 2020.

— Prof. Devi Sridhar (@devisridhar) June 26, 2020

Table 1 sets out one way to describe the distinction between these approaches:

• The UK government is addressing a chronic problem, being cautious about policy change without supportive evidence, identifying trigger points to new approaches (based on incidence), and assuming initially that the approach is based largely on exhortation.
• One alternative is to pursue elimination aggressively, adopting a precautionary principle before there is supportive evidence of a major problem and the effectiveness of solutions, backed by measures such as contact tracing and quarantine, and assuming that the imposition of behaviour should be a continuous expectation.

One approach highlights the lack of evidence to support major policy change, and therefore gives primacy to the status quo. The other is more preventive, giving primacy to the precautionary principle until there is more clarity or certainty on the available evidence.

In that context, note (in Table 2) how frequently the SAGE minutes state that there is limited evidence to support policy change, and that an epidemic is inevitable (in other words, elimination without a vaccine is near-impossible). Both statements tend to support a UK government policy that was, until mid-March, based on reluctance to enforce a profound lockdown to impose social distancing.

As the next post describes, the chronology of Table 2 is instructive, since it demonstrates a degree of path dependence based on initial uncertainty and hesitancy. This approach was understandable at first (particularly when connected to an argument about reducing the peak of infection then avoiding a second wave), before being so heavily criticised only two months later.

The full list of SAGE posts:

COVID-19 policy in the UK: yes, the UK Government did ‘follow the science’

Did the UK Government ‘follow the science’? Reflections on SAGE meetings

The role of SAGE and science advice to government

The overall narrative underpinning SAGE advice and UK government policy

SAGE meetings from January-June 2020

SAGE Theme 1. The language of intervention

SAGE Theme 2. Limited capacity for testing, forecasting, and challenging assumptions

SAGE Theme 3. Communicating to the public

COVID-19 policy in the UK: Table 2: Summary of SAGE minutes, January-June 2020

Update 24.5.21

Dominic Cummings’ tweets 38-55 (22-24 May 2021) describe much of the initial UK Government approach (described above) as a ‘herd immunity’ strategy:

38/ Media generally abysmal on covid but even I’ve been surprised by 1 thing: how many hacks have parroted Hancock’s line that ‘herd immunity wasn’t the plan’ when 'herd immunity by Sep' was *literally the official plan in all docs/graphs/meetings* until it was ditched

— Dominic Cummings (@Dominic2306) May 22, 2021

51/ It was in week of 9/3 that we started to figure out Plan B to dodge herd immunity until vaccines. Even AFTER we shifted to PlanB, COBR documents had the ‘OPTIMAL single peak strategy’ graphs showing 260k dead cos the system was so confused in the chaos, see below pic.twitter.com/kXsgfkQdbF

— Dominic Cummings (@Dominic2306) May 23, 2021

I discuss here why I think ‘herd immunity’ has become a damagingly ambiguous term, used too loosely and misleadingly by too many people to help us understand what happened:

3. Defining the policy problem: ‘herd immunity’, long term management, and the containability of COVID-19 | Paul Cairney: Politics & Public Policy (wordpress.com)

However, clearly these tweets are crucial to our understanding of the influence of initial advice and strategies, based on the idea of acting to mitigate a first peak while avoiding a second.

Three ways to communicate more effectively with policymakers

By Paul Cairney and Richard Kwiatkowski

Use psychological insights to inform communication strategies

Policymakers cannot pay attention to all of the things for which they are responsible, or understand all of the information they use to make decisions. Like all people, there are limits on what information they can process (Baddeley, 2003; Cowan, 2001, 2010; Miller, 1956; Rock, 2008).

They must use short cuts to gather enough information to make decisions quickly: the ‘rational’, by pursuing clear goals and prioritizing certain kinds of information, and the ‘irrational’, by drawing on emotions, gut feelings, values, beliefs, habits, schemata, scripts, and what is familiar, to make decisions quickly. Unlike most people, they face unusually strong pressures on their cognition and emotion.

Policymakers need to gather information quickly and effectively, often in highly charged political atmospheres, so they develop heuristics to allow them to make what they believe to be good choices. Perhaps their solutions seem to be driven more by their values and emotions than a ‘rational’ analysis of the evidence, often because we hold them to a standard that no human can reach.

If so, and if they have high confidence in their heuristics, they will dismiss criticism from researchers as biased and naïve. Under those circumstances, we suggest that restating the need for ‘rational’ and ‘evidence-based policymaking’ is futile, naively ‘speaking truth to power’ counterproductive, and declaring ‘policy based evidence’ defeatist.

We use psychological insights to recommend a shift in strategy for advocates of the greater use of evidence in policy. The simple recommendation, to adapt to policymakers’ ‘fast thinking’ (Kahneman, 2011) rather than bombard them with evidence in the hope that they will get round to ‘slow thinking’, is already becoming established in evidence-policy studies. However, we provide a more sophisticated understanding of policymaker psychology, to help understand how people think and make decisions as individuals and as part of collective processes. It allows us to (a) combine many relevant psychological principles with policy studies to (b) provide several recommendations for actors seeking to maximise the impact of their evidence.

To ‘show our work’, we first summarise insights from policy studies already drawing on psychology to explain policy process dynamics, and identify key aspects of the psychology literature which show promising areas for future development.

Then, we emphasise the benefit of pragmatic strategies, to develop ways to respond positively to ‘irrational’ policymaking while recognising that the biases we ascribe to policymakers are present in ourselves and our own groups. Instead of bemoaning the irrationality of policymakers, let’s marvel at the heuristics they develop to make quick decisions despite uncertainty. Then, let’s think about how to respond effectively. Instead of identifying only the biases in our competitors, and masking academic examples of group-think, let’s reject our own imagined standards of high-information-led action. This more self-aware and humble approach will help us work more successfully with other actors.

On that basis, we provide three recommendations for actors trying to engage skilfully in the policy process:

1. Tailor framing strategies to policymaker bias. If people are cognitive misers, minimise the cognitive burden of your presentation. If policymakers combine cognitive and emotive processes, combine facts with emotional appeals. If policymakers make quick choices based on their values and simple moral judgements, tell simple stories with a hero and moral. If policymakers reflect a ‘group emotion’, based on their membership of a coalition with firmly-held beliefs, frame new evidence to be consistent with those beliefs.
2. Identify ‘windows of opportunity’ to influence individuals and processes. ‘Timing’ can refer to the right time to influence an individual, depending on their current way of thinking, or to act while political conditions are aligned.
3. Adapt to real-world ‘dysfunctional’ organisations rather than waiting for an orderly process to appear. Form relationships in networks, coalitions, or organisations first, then supply challenging information second. To challenge without establishing trust may be counterproductive.

These tips are designed to produce effective, not manipulative, communicators. They help foster the clearer communication of important policy-relevant evidence, rather than imply that we should bend evidence to manipulate or trick politicians. We argue that it is pragmatic to work on the assumption that people’s beliefs are honestly held, and policymakers believe that their role is to serve a cause greater than themselves. To persuade them to change course requires showing simple respect and seeking ways to secure their trust, rather than simply ‘speaking truth to power’. Effective engagement requires skilful communication and good judgement as much as good evidence.

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This is the introduction to our revised and resubmitted paper to the special issue of Palgrave Communications The politics of evidence-based policymaking: how can we maximise the use of evidence in policy? Please get in touch if you are interested in submitting a paper to the series.

Full paper: Cairney Kwiatkowski Palgrave Comms resubmission CLEAN 14.7.17

The impact of multi-level policymaking on the UK energy system

In September, we will begin a one-year UKERC project examining current and future energy policy and multi-level policymaking and its impact on ‘energy systems’. This is no mean feat, since the meaning of policy, policymaking (or the ‘policy process’), and ‘system’ are not clear, and our description of the components parts of an energy system and a complex policymaking system may differ markedly. So, one initial aim is to provide some way to turn a complex field of study into something simple enough to understand and engage with.

We do so by focusing on ‘multi-level policymaking’ – which can encompass concepts such as multi-level governance and intergovernmental relations – to reflect the fact that the responsibility for policies relevant to energy are often Europeanised, devolved, and shared between several levels of government. Brexit will produce a major effect on energy and non-energy policies, and prompt the UK and devolved governments to produce relationships, but we all need more clarity on the dynamics of current arrangements before we can talk sensibly about the future. To that end, we pursue three main work packages:

1. What is the ‘energy policymaking system’ and how does it affect the energy system?

Chaudry et al (2009: iv) define the UK energy system as ‘the set of technologies, physical infrastructure, institutions, policies and practices located in and associated with the UK which enable energy services to be delivered to UK consumers’. UK policymaking can have a profound impact, and constitutional changes might produce policy change, but their impacts require careful attention. So, we ‘map’ the policy process and the effect of policy change on energy supply and demand. Mapping sounds fairly straightforward but contains a series of tasks whose level of difficulty rises each time:

1. Identify which level or type of government is responsible – ‘on paper’ and in practice – for the use of each relevant policy instrument.
2. Identify how these actors interact to produce what we call ‘policy’, which can range from statements of intent to final outcomes.
3. Identify an energy policy process containing many actors at many levels, the rules they follow, the networks they form, the ‘ideas’ that dominate discussion, and the conditions and events (often outside policymaker control) which constrain and facilitate action. By this stage, we need to draw on particular policy theories to identify key venues, such as subsystems, and specific collections of actors, such as advocacy coalitions, to produce a useful model of activity.

2. Who is responsible for action to reduce energy demand?

Energy demand is more challenging to policymakers than energy supply because the demand side involves millions of actors who, in the context of household energy use, also constitute the electorate. There are political tensions in making policies to reduce energy demand and carbon where this involves cost and inconvenience for private actors who do not necessarily value the societal returns achieved, and the political dynamics often differ from policy to regulate industrial demand. There are tensions around public perceptions of whose responsibility it is to take action – including local, devolved, national, or international government agencies – and governments look like they are trying to shift responsibility to each other or individuals and firms.

So, there is no end of ways in which energy demand could be regulated or influenced – including energy labelling and product/building standards, emissions reduction measures, promotion of efficient generation, and buildings performance measures – but it is an area of policy which is notoriously diffuse and lacking in co-ordination. So, for the large part, we consider if Brexit provides a ‘window of opportunity’ to change policy and policymaking by, for example, clarifying responsibilities and simplifying relationships.

3: Does Brexit affect UK and devolved policy on energy supply?

It is difficult for single governments to coordinate an overall energy mix to secure supply from many sources, and multi-level policymaking adds a further dimension to planning and cooperation. Yet, the effect of constitutional changes is highly uneven. For example, devolution has allowed Scotland to go its own way on renewable energy, nuclear power and fracking, but Brexit’s impact ranges from high to low. It presents new and sometimes salient challenges for cooperation to supply renewable energy but, while fracking and nuclear are often the most politically salient issues, Brexit may have relatively little impact on policymaking within the UK.

We explore the possibility that renewables policy may be most impacted by Brexit, while nuclear and fracking are examples in which Brexit may have a minimal direct impact on policy. Overall, the big debates are about the future energy mix, and how local, devolved, and UK governments balance the local environmental impacts of, and likely political opposition to, energy development against the economic and energy supply benefits.

For more details, see our 4-page summary

Powerpoint for 13.7.17

Cairney et al UKERC presentation 23.10.17

No one will understand British politics and policymaking after Brexit

Let’s be optimistic for a few seconds, and focus on the idea that a vote for the UK to leave the European Union was a vote for UK sovereignty and ‘taking back control’ of policy and policymaking. The comparison is between an EU process that is distant and undemocratic and a UK process we can all understand and influence, following the simple phrase ‘if you know who is in charge, you know who to blame’.

The down side is that we don’t know who is in charge, and it’s often futile to try to find a named individual or role to blame. The EU certainly complicates the picture, but don’t be fooled into thinking that we will eventually produce a UK political system that anyone understands.

If giving a lecture, this is the point at which I’d pause for effect and restate the idea that no-one understands the UK policymaking system as a whole [insert meaningful looks here]. Many people know about many parts of the system, but it’s not like a jigsaw puzzle that we’ve completed by working together. At best, it’s like that Dalmatian jigsaw that we started at Christmas before getting drunk and falling out.

Instead, policymakers and commentators tell simple stories about British politics

The dominant story of British politics relates initially to the idea of parliamentary sovereignty: we vote in constituencies to elect MPs as our representatives, and MPs as a whole represent the final arbiters on policy in the UK. This idea connects strongly to elements of the ‘Westminster model’ (WM), a shorthand phrase to describe key ways in which the UK political system is perhaps designed to work. Perhaps policymaking should reflect strongly the wishes of the public. In representative democracies, political parties engage each other in a battle of ideas, to attract the attention and support of the voting public; the public votes every 4-5 years; the winner forms a government; the government turns its manifesto into policy; and, policy choices are carried out by civil servants and other bodies. In other words, there should be a clear link between public preferences, the strategies and ideas of parties and the final result.

The WM serves this purpose in a particular way: the UK has a plurality (‘first past the post’) voting system which tends to exaggerate support for, and give a majority in Parliament to, the winning party. It has an adversarial (and majoritarian?) style of politics and a ‘winner takes all’ mentality which tends to exclude opposition parties. The executive resides in the legislature and power tends to be concentrated within government – in ministers that head government departments and the Prime Minister who heads (and determines the members of) Cabinet. The government is responsible for the vast majority of public policy and it uses its governing majority, combined with a strong party ‘whip’, to make sure that its legislation is passed by Parliament.

In other words, the ‘take home message’ of this story is that the UK policy process is centralised and that the arrangement reflects a ‘British political tradition’: the government is accountable to public on the assumption that it is powerful and responsible. So, you know who is in charge and therefore who to praise or blame, and elections every 4-5 years are supplemented by parliamentary scrutiny built on holding ministers directly to account.

These stories are more useful for our entertainment than enlightenment

Consider these five factors which challenge the ability of elected policymakers to control the policy process.

1. Bounded rationality. Ministers only have the ability to pay attention to a tiny proportion of the issues over which have formal responsibility. So, how can they control issues if they have to ignore almost all of them?
2. Policy communities. Ministers delegate responsibility to civil servants at a quite-low level of government. Civil servants make policy in consultation with interest groups and other participants with the ability to trade resources (such as information) for access or influence. Such relationships can endure long after particular ministers or elected governments have come and gone.
3. Multi-level governance. The UK government shares policymaking ‘vertically’ (with international, EU, devolved, and local governments) and ‘horizontally’ (with non-governmental and quasi-non-governmental organisations).
4. Complex government. Policymaking ‘emerges’ from the interaction between many actors, institutions, and regulations. In complex policymaking systems, people act without full knowledge of how other people act elsewhere in the system.
5. Policy environments. Many policy conditions and events are out of policymakers’ control (including demographic, technological, and economic change)

So, for example, the UK government has to juggle two stories of British politics – on the need to be pragmatic in the face of these five challenges to their power and sense of control, versus the need to construct a strong image of governing competence with reference to control – in the knowledge that one of them is a tall tale.

Brexit will change only one part of that story

None of these factors should prompt us to minimise the influence of the EU on the UK. Rather, they should prompt us to think harder about the impact of Brexit on ‘parliamentary sovereignty’ and ministerial accountability via UK central government control. The phrase ‘you know who is in charge, and who to blame’ will become a more important rallying cry in British politics (when we can no longer blame the EU for British policy), but let’s focus on what actually happens in British politics and recognise how little of it we understand before we decide who to blame.

This post is an amended version of the introductory post for the course POLU9UK: Policy and Policymaking in the UK which draws on this ‘1000 Words’ series on public policy.

 

Writing an essay on politics, policymaking, and policy change

I tend to set this simple-looking question for coursework in policy modules: what is policy, how much has it changed, and why? Students get to choose the policy issue, timeframe (and sometimes the political system), and relevant explanatory concepts.

On the face of it, it looks super-simple: A+ for everyone!

Give it a few more seconds, and you can see the difficulties:

1. We spent a lot of time agreeing that it seems almost impossible to define policy (explained in 1000 Words and 500 Words)
2. There are a gazillion possible measures of policy change (1000 Words and 500 Words)
3. There is an almost unmanageable number of models, concepts, and theories to use to explain policy dynamics (I describe about 25 in 1000 Words each)

I try to encourage some creativity when solving this problem, but also advise students to keep their discussion as simple and jargon-free as possible (often by stretching an analogy with diving, in which a well-executed simple essay can score higher than a belly-flopped hard essay).

Choosing a format: the initial advice

1. Choose a policy area (such as health) or issue (such as alcohol policy).
2. Describe the nature of policy, and the extent of policy change, in a particular time period (such as in the post-war era, since UK devolution, or since a change in government).
3. Select one or more policy concept or theory to help structure your discussion and help explain how and why policy has changed.

For example, a question might be: What is tobacco policy in the UK, how much has it changed since the 1980s, and why? I use this example because I try to answer that – UK and global – question myself, even though my 2007 article on the UK is too theory-packed to be a good model for an undergraduate essay.

Choosing a format: the cautionary advice

You may be surprised about how difficult it is to answer a simple question like ‘what is policy?’ and I will give you considerable credit for considering how to define and measure it, by identifying, for example, the use of legislation/ regulation, funding, staff, and ‘nodality’ and/ or by considering the difference between, say, policy as a statement of intent or a long term outcome. In turn, a good description and explanation of policy change is difficult. If you are feeling ambitious, you can go further, to compare, say, two issues (such as tobacco and alcohol) or places (such UK Government policy and the policy of another country), but sometimes a simple and narrow discussion can be as, or more, effective. Similarly, you can use many theories or concepts to aid explanation, but often one theory will do. Note that (a) your description of your research question, and your essay structure, is more important than (b) your decision on what topic to focus or concepts to use.

Choosing a topic: the ‘joined up’ advice

The wider aim is to encourage students to think about the relationship between different perspectives on policy theory and analysis. For example, in a blog and policy analysis paper they try to generate attention to a policy problem and advocate a solution. Then, they draw on policy theories and concepts to reflect on their papers, highlighting (say): the need to identify the most important audience; the importance of framing issues with a mixture of evidence and emotional appeals; and, the need to present ‘feasible’ solutions.

The reflection can provide a useful segue to the essay, since we’re already identifying important policy problems, advocating change, reflecting on how best to encourage it – such as by presenting modest objectives – and then, in the essay, trying to explain (say) why governments have not taken that advice in the past. Their interest in the policy issue can prompt interest in researching the issue further; their knowledge of the issue and the policy process can help them develop politically-aware policy analysis. All going well, it produces a virtuous circle.

Some examples from my pet subject

Let me outline how I would begin to answer the three questions with reference to UK tobacco policy. I’m offering a brief summary of each section rather than presenting a full essay with more detail (partly to hold on to that idea of creativity – I don’t want students to use this description as a blueprint).

What is modern UK tobacco policy?

Tobacco policy in the UK is now one of the most restrictive in the world. The UK government has introduced a large number of policy instruments to encourage a major reduction of smoking in the population. They include: legislation to ban smoking in public places; legislation to limit tobacco advertising, promotion, and sponsorship; high taxes on tobacco products; unequivocal health education; regulations on tobacco ingredients; significant spending on customs and enforcement measures; and, plain packaging measures.

[Note that I selected only a few key measures to define policy. A fuller analysis might expand on why I chose them and why they are so important].

How much has policy changed since the 1980s?

Policy has changed radically since the post-war period, and most policy change began from the 1980s, but it was not until the 2000s onwards that the UK cemented its place as one of the most restrictive countries. The shift from the 1980s relates strongly to the replacement of voluntary agreements and limited measures with limited enforcement with legislative measures and stronger enforcement. The legislation to ban tobacco advertising, passed in 2002, replaced limited bans combined with voluntary agreements to (for example) keep billboards a certain distance from schools. The legislation to ban smoking in public places, passed in 2006 (2005 in Scotland), replaced voluntary measures which allowed smoking in most pubs and restaurants. Plain packaging measures, combined with large and graphic health warnings, replace branded packets which once had no warnings. Health education warnings have gone from stating the facts and inviting smokers to decide, and the promotion of harm reduction (smoke ‘low tar’), to an unequivocal message on the harms of smoking and passive smoking.

[Note that I describe these changes in broad terms. Other articles might ‘zoom’ in on specific instruments to show how exactly they changed]

Why has it changed?

This is the section of the essay in which we have to make a judgement about the type of explanation: should you choose one or many concepts; if many, do you focus on their competing or complementary insights; should you provide an extensive discussion of your chosen theory?

I normally recommend a very small number of concepts or simple discussion, largely because there is only so much you can say in an essay of 2-3000 words.

For example, a simple ‘hook’ is to ask if the main driver was the scientific evidence: did policy change as the evidence on smoking (and then passive smoking) related harm became more apparent? Is it a good case of ‘evidence based policymaking’? The answer may then note that policy change seemed to be 20-30 years behind the evidence [although I’d have to explain that statement in more depth] and set out the conditions in which this driver would have an effect.

In short, one might identify the need for a ‘policy environment’, shaped by policymakers, and conducive to a strong policy response based on the evidence of harm and a political choice to restrict tobacco use. It would relate to decisions by policymakers to: frame tobacco as a public health epidemic requiring a major government response (rather than primarily as an economic good or issue of civil liberties); place health departments or organisations at the heart of policy development; form networks with medical and public health groups at the expense of tobacco companies; and respond to greater public support for control, reduced smoking prevalence, and the diminishing economic value of tobacco.

This discussion can proceed conceptually, in a relatively straightforward way, or with the further aid of policy theories which ask further questions and help structure the answers.

For example, one might draw on punctuated equilibrium theory to help describe and explain shifts of public/media/ policymaker attention to tobacco, from low and positive in the 1950s to high and negative from the 1980s.

Or, one might draw on the ACF to explain how pro-tobacco coalitions helped slow down policy change by interpreting new scientific evidence though the ‘lens’ of well-established beliefs or approaches (examples from the 1950s include filter tips, low tar brands, and ventilation as alternatives to greater restrictions on smoking).

One might even draw on multiple streams analysis to identify a ‘window of opportunity for change (as I did when examining the adoption of bans on smoking in public places).

Any of these approaches will do, as long as you describe and justify your choice well. One cannot explain everything, so it may be better to try to explain one thing well.

What happens when UK Governments try to control and delegate policymaking? #POLU9UK

To celebrate Andy Murray becoming number 1, I have recorded the podcast in the style of him giving an interview:

 

British politics looks weird because UK governments have contradictory incentives: to look like they are in control, but delegate most, of policymaking; to take but shuffle off responsibility for policy outcomes; to hold on and let go.

These incompatible incentives reflect our incompatible stories of British politics:

• One stresses central control, the other stresses complexity and emergent outcomes despite central government intervention
• One stresses the need for central control to ensure clear lines of accountability, the other stresses the need for pragmatism and how ridiculous it is to hold people to account for things over which they have minimal control.
• One gets all the attention, despite being misleading, partly because it relates to a simple and comforting message on accountability and the exciting world of high politics. The other gets little attention, despite being more accurate, because its message is confusing and often boring.

So, when we discuss the big post-war developments in British politics, and their impact on policymaking and accountability, we should not expect to find a grand or consistent plan. Instead, post war government reforms reflect these contradictions, and prompt a tendency for elected policymakers to delegate or ‘shuffle off’ most responsibility but intervene in unpredictable and inconsistent ways.

What were these big changes? 1. A shift from state to market?

I say this not to diminish the argument that major changes from the 1970s, to alter the balance between the state and market in the UK, were often ideologically driven. Rather, don’t assume that the consistent/systematic application of that ideology is the main explanation. In some cases, governments:

• diluted their reformist beliefs, preferring pragmatism and realistic aims
• pursued reforms for simple aims such as to bolster their popularity
• accepted or reinforced the actions of their predecessors (even if from another party)
• pursued major reforms after key events and crises seemed to force their hand.

Overall, politics is often about telling a story about handling government or crises well, not actually controlling events and outcomes, and no single elected government can oversee a 10, 20, or 30-year plan to reform the state in the scale we witnessed.

Still, we can now see fundamental differences when we compare the UK state with that of the 1970s. Examples include:

• A ‘paradigm’ shift in economic policy, from ‘Keynesian’ to ‘monetarist’ economics (see Hall), prompted by economic crisis in the 1970s under Labour and the election of a Conservative government in 1979. For example, governments no longer promise to achieve ‘full employment’ via measures such as capital investment (indeed, the Thatcher government appeared to accept high unemployment while favouring inflation controls).
• Privatisation. The sale of public assets (including major nationalised utilities and local authority owned social housing), break up of state monopolies, injection of competition in the public sector, introduction of public–private partnerships for major capital projects, and charging for government services.

In both cases, you can see one form of this debate on central control playing out: for some advocates of economic reform and privatisation, this was about producing a ‘rejuvenated’ and ‘lean’ state, with ministers able to focus on core tasks – making strategic decisions and creating rules for others to follow – without having to pretend that they can control the economy or manage major industries. In this account, post-war developments were based on the idea of state planning and central control over the economy and most public services, while post-79 developments were driven by the belief that such planning had failed.

Although prompted by the Conservative government of 1979-97, the Labour government from 1997-2010 reinforced most measures (and privatised more services than Thatcher would have envisaged). It also extended the idea of limiting central government ministerial intervention in the economy by introducing Bank of England independence (making it primarily responsible for interest rates and strategies to manage inflation).

2. A shift from ‘rowing’ to ‘steering’?

This ‘lean’ theme is summed up in the metaphor (made famous by management consultants Osborne and Gaebler) of ‘steering, not rowing’, in which governments decide to provide direction to public services/ public servants rather than managing them directly. Also look out for the phrase ‘new public management’ (NPM) which mostly describes the application of private business methods to the public sector. Examples include:

• Civil service reforms to separate strategic ministerial/ operational decisions and make public servants more directly accountable for the latter.
• Quasi-markets. Public bodies like hospitals and schools are given greater operational independence. One part of the public sector competes with another for (say) the business of commissioning agencies and/ or to compete in league tables of performance.
• Quangos. The increased use of quasi-non-governmental bodies, sponsored by government departments but operating at ‘arms-length’ from elected policymakers.
• Public sector reforms in which non-governmental bodies play an increasing role in service delivery while subject to regulation, inspection, and performance management.

3. Constitutional

These reforms, often designed to give a sense of reinforced central control, are different from decisions by the UK government to shift power upwards, to the European Union, and downwards,(a) in 1999, to devolved governments in Scotland, Wales and Northern Ireland, and (b) through various experiments in regional government (in the early 2000s) and ‘localism’ (from 2010).

What is the overall effect of these reforms?

These reforms prompted several debates about the modern nature of the UK state, based on questions such as, Is it ‘hollowing’ or rejuvenated?

• Is UK central government now less able to influence policy outcomes, and more reliant on persuasion and cooperation from many actors in policy networks? Do we talk about multi-level governance, not government, because no single government can control policy? Is this the great irony of reform: they were designed to reinforce central control but they actually exacerbated the UK’s governance problem?
• Or, has central government shuffled off direct responsibility for the previously unmanageable parts of the public sector that took up a disproportionate amount of ministerial energy (major industries, local government, Scotland), and become more powerful via regulatory mechanisms or more able to shift blame?

When considering these questions, note how this UK-specific discussion can be supplemented by the ‘universal’ factors we discuss in POLU9UK and covered in the 1000 Words series, including: ministers are boundedly rational, operating in a policy environment with a huge number of actors, and apparently unable to control outcomes that ‘emerge’ from complex systems. In other words, the answer to the ‘hollowing’ question will not come only from an analysis of UK government policies.

What is the effect on ministerial accountability?

As in Scotland, the UK Government has experimented with many forms of accountability based on one of these two stories of central government:

1. Westminster-style democratic accountability, through periodic elections and more regular reports by ministers to Westminster. This requires a strong sense of central government and ministerial control – if you know who is in charge, you know who to hold to account or reward or punish in the next election.
2. Institutional accountability, through performance management measures applied to the chief executives of public bodies, such as elected local authorities and unelected agencies and quangos.
3. Accountability via pluralist democracy, fostering the shared ‘ownership’ of policy with stakeholders to produce choices that both support.
4. Localist democracy, encouraging a sense of collective responsibility between local authorities and their stakeholders.
5. User based notions of accountability, when a public body considers its added value to (and responds to the wishes of) service users, or public bodies and users ‘co-produce’ and share responsibility for the outcomes.

Yet, 2-5 generally seem incompatible with, or overshadowed by, 1. Ministers think that the public expects Westminster-style accountability, so they try these other measures but also:

• Try to show that they still control the direction of delegated services, often with reference to problematic proxies of their own success (see the example of Troubled Families)
• Intervene in an ad hoc way in the decisions of public bodies that they’d otherwise like to run themselves (see Gains and Stoker)
• Or, they seem to delegate power to public bodies but introduce so many regulations, budget limits, and performance measures that it is difficult for those bodies to exert their autonomy (see the example of ‘prevention policy’, in which central governments simultaneously support and scupper various forms of prevention and early intervention).

Group work

In groups we can discuss these major reforms and the extent to which they were driven by a grand plan or a series of unfortunate events.

We can discuss accountability and try to explain how and why ministers intervene in some areas but not others.

Since we focused on the two basic stories of (lack of) control in week 2, this week we can zoom in to discuss specific measures to demonstrate success in government or produce the appearance of control. What examples spring to mind?

Policy networks and communities #POLU9UK

As we discussed in week 2, if you start your study of British politics by describing the Westminster model, you get something like this:

Key parts of the Westminster political system help concentrate power in the executive. Representative democracy is the basis for most participation and accountability. The UK is a unitary state built on parliamentary sovereignty and a fusion of executive and legislature, not a delegation or division of powers. The plurality electoral system exaggerates single party majorities, the whip helps maintain party control of Parliament, the government holds the whip, and the Prime Minister controls membership of the government. So, you get centralised government and you know who is in charge and therefore to blame.

Yet, if you read the recommended reading, you get this:

Most contemporary analysts dwell on the shortcomings of the Westminster account and compare it with a more realistic framework based on modern discussions of governance … Britain has moved away from a distinctive Westminster model.

And, if you read this post on the pervasiveness of policy networks and communities, you get something like this:

‘Policy networks’ or ‘policy communities’ represent the building blocks of policy studies. Most policy theories situate them at the heart of the policy process.

So, you may want to know: ‘How did we get from the one case of affairs to the other case of affairs?’ (source). Here are some possible explanations to discuss.

One account is wrong

In our grumpy account, we pretty much complain that the incorrect story still wins because it sounds so good. The uncool academics have all agreed that the ‘governance’ story best sums up British politics, but the media and public don’t pay attention to it, politicians act as if it doesn’t exist, and cool Lijphart gets all the attention with his ‘majoritarian’ model of the UK which accentuates the adversarial and top-down nature compared to the utopian consensus democracies in which all politicans hold hands and sing together before agreeing all their policies.

One account is wrong most of the time

When less grumpy, we suggest that our account is correct most of the time. People pay attention to the exciting world of elected politics and governing politicians, but it represents the tip of the iceberg. Most policy is processed below the surface, away from the public spotlight, and this process does not match the UK’s majoritarian image. Instead, policymakers tend to work routinely with other policy participants to share information and advice and come to collective understandings of problems and feasible solutions.

What explains the shift from one image to the other?

If we go for the latter explanation, we need to know how this process works: what prompts a tiny number of issues to receive the excitement and attention and a huge number to receive almost none? I’ll give you some ideas below, but note that you can find the same basic explanation of this agenda setting/ framing process in many theories of the policy process. You should read as many as possible and, in particular, those on framing, punctuated equilibrium, and power/ideas. Combined, you get the sense of two scenarios: one in which people simply can’t pay attention to many policy issues and have to ignore most; and, one in which people exploit this limitation to make sure that some issues are ignored (for example, by framing issues as ‘solved’ by policymakers, with only experts required to oversee the implementation of key choices).

The general explanation: powerful people have limited attention

You’ll find this general explanation squirrelled away somewhere in almost everything I’ve written. In this case, it’s in the networks 1000 words post:

• The size and scope of the state is so large that it is in danger of becoming unmanageable. The same can be said of the crowded environment in which huge numbers of actors seek policy influence. Consequently, the state’s component parts are broken down into policy sectors and sub-sectors, with power spread across government.
• Elected policymakers can only pay attention to a tiny proportion of issues for which they are responsible. So, they pay attention to a small number and ignore the rest. In effect, they delegate policymaking responsibility to other actors such as bureaucrats, often at low levels of government.
• At this level of government and specialisation, bureaucrats rely on specialist organisations for information and advice.
• Those organisations trade that information/advice and other resources for access to, and influence within, the government (other resources may relate to who groups represent – such as a large, paying membership, an important profession, or a high status donor or corporation).
• Therefore, most public policy is conducted primarily through small and specialist policy communities that process issues at a level of government not particularly visible to the public, and with minimal senior policymaker involvement.

A specific explanation: even ‘majoriarian’ governments seek consensus even when issues become high profile

I like this story about Brent Spar as an example of ‘bureaucratic accommodation’. In a nutshell (from p577), they argue that we began with a high profile issue in which Greenpeace occupied a Shell oil rig that was due for disposal, got Shell to change its policy through high profile campaigning, but that they came to quieter agreement within government by agreeing on specific policies without shifting their basic principles. Many of us saw the conflict but few saw the consensus building that followed (and, in fact, preceded these events). There are many stories like this, in which relatively short periods of highly salient policymaking ‘punctuate’ much longer spells of humdrum activity.

Group activities

So, in our group work we can explore the key themes through examples. I’ll ask you to identify the conditions under which Westminster-model-style activity happens, and the conditions under which we’d expect policy communities to develop. I’ll ask you to compare issues in which there is high salience and conflict with issues that are low salience and/ or low conflict. I might even ask you to remember some high profile issues from the past then ask: where are they now?

 

 

 

 

Policymaking in the UK: do you really know who is in charge and who to blame? #POLU9UK

This week, we continue with the idea of two stories of British politics. In one, the Westminster model-style story, the moral is that the centralisation of power produces clear lines of accountability: you know who is in charge and, therefore, the heroes or villains. In another, the complex government story, the world seems too messy and power too diffuse to know all the main characters.

Although some aspects of these stories are specific to the UK, they relate to some ‘universal’ questions and concepts that we can use to identify the limits to centralised power. Put simply, some rather unrealistic requirements for the Westminster story include:

1. You know what policy is, and that it is made by a small number of actors at the heart of government.
2. Those actors possess comprehensive knowledge about the problems and solutions they describe.
3. They can turn policy intent into policy outcomes in a straightforward way.

If life were that simple, I wouldn’t be asking you to read the following blog posts (underlined) which complicate the hell out of our neat story:

You don’t know what policy is, and it is not only made by a small number of actors at the heart of government.

We don’t really know what government policy is. In fact, we don’t even know how to define ‘public policy’ that well. Instead, a definition like ‘the sum total of government action, from signals of intent to the final outcomes’ raises more issues than it settles: policy is remarkably difficult to identify and measure; it is made by many actors inside, outside, and sort of inside/outside government; the boundary between the people influencing and making policy is unclear; and, the study of policy is often about the things governments don’t do.

Actors don’t possess comprehensive knowledge about the problems and solutions they describe

It’s fairly obvious than no-one possesses all possible information about policy problems and the likely effects of proposed solutions. It’s not obvious what happens next. Classic discussions identified a tendency to produce ‘good enough’ decisions based on limited knowledge and cognitive ability, or to seek other measures of ‘good’ policy such as their ability to command widespread consensus (and no radical movement away from such policy settlements). Modern discussions offer us a wealth of discussions of the implications of ‘bounded rationality’, but three insights stand out:

1. Policymakers pay disproportionate attention to a tiny proportion of the issues for which they are responsible. There is great potential for punctuations in policy/ policymaking when their attention lurches, but most policy is made in networks in the absence of such attention.
2. Policymakers combine ‘rational’ and ‘irrational’ ways to make decisions with limited information. The way they frame problems limits their attention to a small number of possible solutions, and that framing can be driven by emotional/ moral choices backed up with a selective use of evidence.
3. It is always difficult to describe this process as ‘evidence-based policymaking’ even when policymakers have sincere intentions.

Policymakers cannot turn policy intent into policy outcomes in a straightforward way

The classic way to describe straightforward policymaking is with reference to a policy cycle and its stages. This image of a cycle was cooked up by marketing companies trying to sell hula hoops to policymakers and interest groups in the 1960s. It is not an accurate description of policymaking (but spirographs are harder to sell).

Instead, for decades we have tried to explain the ‘gap’ between the high expectations of policymakers and the actual – often dispiriting- outcomes, or wonder if policymakers really have such high expectations for success in the first place (or if they prefer to focus on how to present any of their actions as successful). This was a key topic before the rise of ‘multi-level governance’ and the often-deliberate separation of central government action and expected outcomes.

The upshot: in Westminster systems do you really know who is in charge and who to blame?

These factors combine to generate a sense of complex government in which it is difficult to identify policy, link it to the ‘rational’ processes associated with a small number of powerful actors at the heart of government, and trace a direct line from their choices to outcomes.

Of course, we should not go too far to argue that governments don’t make a difference. Indeed, many ministers have demonstrated the amount of damage (or good) you can do in government. Still, let’s not assume that the policy process in the UK is anything like the story we tell about Westminster.

Seminar questions

In the seminar, I’ll ask you reflect on these limits and what they tell us about the ‘Westminster model’. We’ll start by me asking you to summarise the main points of this post. Then, we’ll get into some examples in British politics.

Try to think of some relevant examples of what happens when, for example, minsters seem to make quick and emotional (rather than ‘evidence based’) decisions: what happens next? Some obvious examples – based on our discussions so far – include the Iraq War and the ‘troubled families’ agenda, but please bring some examples that interest you.

In group work, I’ll invite you to answer these questions:

1. What is UK government policy on X? Pick a topic and tell me what government policy is.
2. How did the government choose policy? When you decide what government policy is, describe how it made its choices.
3. What were the outcomes? When you identify government policy choices, describe their impact on policy outcomes.

I’ll also ask you to identify at least one blatant lie in this blog post.

Week 2. Two stories of British politics: the Westminster model versus Complex Government #POLU9UK

I want you to think about the simple presentation of complex thought.

• How do we turn a world which seems infinitely complex into an explanation which describes that world in a few minutes or seconds?

• How do we choose the information on which to focus, at the expense of all other information, and generate support for that choice?

• How do we persuade other people to act on that information?

To that end, this week we focus on two stories of politics, and next month you can use these questions to underpin your coursework.

Imagine the study of British politics as the telling of policymaking stories.

We can’t understand or explain everything about politics. Instead, we turn a complex world into a set of simple stories in which we identify, for example, the key actors, events and outcomes. Maybe we’ll stick to dry description, or maybe we’ll identify excitement, heroes, villains, and a moral. Then, we can compare these tales, to see if they add up to a comprehensive account of politics, or if they give us contradictory stories and force us to choose between them.

As scholars, we tell these stories to help explain what is happening, and do research to help us decide which story seems most convincing. However, we also study policymakers who use such stories to justify their action, or the commentators using them to criticise the ineffectiveness of those policymakers. So, one intriguing and potentially confusing prospect is that we can tell stories about policymakers (or their critics) who tell misleading stories!

Remember King Canute (Cnut)

Source

If you’re still with me, have a quick look at Hay’s King Canute article (or my summary of it). Yes, that’s right: he got a whole article out of King Canute. I couldn’t believe it either. I was gobsmacked when I realised how good it was too. For our purposes, it highlights three things:

1. We’ll use the same shorthand terms – ‘Westminster model’, ‘complex government’ – but let’s check if we tell the same stories in the same way.
2. Let’s check if we pick the same moral. For example, if ministers don’t get what they want, is it because of bad policymaking or factors outside of their control? Further, are we making empirical evaluations and/or moral judgements?
3. Let’s identify how policymakers tell that story, and what impact the telling has on the outcome. For example, does it help get them re-elected? Does the need or desire to present policymaking help or hinder actual policymaking? Is ‘heresthetic’ a real word?

The two stories

This week, we’ll initially compare two stories about British politics: the Westminster Model and Complex Government. I present them largely as contrasting accounts of politics and policymaking, but only to keep things simple at first.

One is about central control in the hands of a small number of ministers. It contains some or all of these elements, depending on who is doing the telling:

1. Key parts of the Westminster political system help concentrate power in the executive. Representative democracy is the basis for most participation and accountability. The UK is a unitary state built on parliamentary sovereignty and a fusion of executive and legislature, not a delegation or division of powers. The plurality electoral system exaggerates single party majorities, the whip helps maintain party control of Parliament, the government holds the whip, and the Prime Minister controls membership of the government.
2. So, you get centralised government and you know who is in charge and therefore to blame.

Another is about the profound limits to the WM:

1. No-one seems to be in control. The huge size and reach of government, the potential for ministerial ‘overload’ and need to simplify decision-making, the blurry boundaries between the actors who make and influence policy, the multi-level nature of policymaking, and, the proliferation of rules and regulations, many of which may undermine each other, all contribute to this perception.
2. If elected policymakers can’t govern from the centre, you don’t get top-down government.

What is the moral of these stories?

For us, a moral relates to (a) how the world works or should work, (b) what happens when it doesn’t work in the way we expect, (c) who is to blame for that, and/ or (d) what we should do about it.

For example, what if we start with the WM as a good thing: you get strong, decisive, and responsible government and you know who is in charge and therefore to blame. If it doesn’t quite work out like that, we might jump straight to pragmatism: if elected policymakers can’t govern from the centre, you don’t get strong and decisive government, it makes little sense to blame elected policymakers for things outside of their control, and so we need more realistic forms of accountability (including institutional, local, and service-user).

Who would buy that story though? We need someone to blame!

Yet, things get complicated when you try to identify a moral built on who to blame for it:

There is a ‘universal’ part of the story, and it is difficult to hold a grudge against the universe. In other words, think of the aspects of policymaking that seem to relate to limitations such as ‘bounded rationality’. Ministers can only pay attention to a fraction of the things for which they are formally in charge. So, they pay disproportionate attention to a small number of issues and ignore the rest. They delegate responsibility for those tasks to civil servants, who consult with stakeholders to produce policy. Consequently, there is a blurry boundary between formal responsibility and informal influence, often summed up by the term governance rather than government. A huge number of actors are involved in the policy process and it is difficult to separate their effects. Instead, think of policy outcomes as the product of collective action, only some of which is coordinated by central government. Or, policy outcomes seem to ‘emerge’ from local practices and rules, often despite central government attempts to control them.

There is UK–specific part of the story, but it’s difficult to blame policymakers that are no longer in government. UK Governments have exacerbated the ‘governance problem’, or the gap between an appearance of central control and what central governments can actually do. A collection of administrative reforms from the 1980s, many of which were perhaps designed to reassert central government power, has reinforced a fragmented public landscape and a periodic sense that no one is in control. Examples include privatisation, civil service reforms, and the use of quangos and non-governmental organisations to deliver policies. Further, a collection of constitutional reforms has shifted power up to the EU and down to devolved and regional or local authorities.

How do policymakers (and their critics) tell these stories, how should they tell them, and what is the effect in each case?

Let’s see how many different stories we can come up with, perhaps with reference to specific examples. Their basic characteristics might include:

• Referring primarily to the WM, to blame elected governments for not fulfilling their promises or for being ineffectual. If they are in charge, and they don’t follow through, it’s their fault linked to poor judgement.
• Referring to elements of both stories, but still blaming ministers. Yes, there are limits to central control but it’s up to ministers to overcome them.
• Referring to elements of both stories, and blaming other people. Ministers gave you this task, so why didn’t you deliver?
• Referring to CG, and blaming more people. Yes, there are many actors, but why the hell can’t they get together to fix this?
• Referring to CG and wondering if it makes sense to blame anyone in particular. It’s the whole damn system! Government is a mystery wrapped in a riddle inside an enigma.

In broader terms, let’s discuss what happens when our two initial stories collide: when policymakers need to find a way to balance a pragmatic approach to complexity and the need to describe their activities in a way that the public can understand and support.

For example, do they try to take less responsibility for policy outcomes, to reflect their limited role in complex government, and/ or try to reassert central control, on the assumption that they may as well be more influential if they will be held responsible?

The answer, I think, is that they try out lots of solutions at the same time:

• They try to deliver as many manifesto promises as possible, and the manifesto remains a key reference point for ministers and civil servants.
• They often deal with ‘bounded rationality’ by making quick emotional and moral choices about ‘target populations’ before thinking through the consequences
• In cases of ‘low politics’ they might rely on policy communities and/ or seek to delegate responsibility to other public bodies
• In cases of ‘high politics’, they need to present an image of governing competence based on central control, so they intervene regularly
• Sometimes low politics becomes high politics, and vice versa, so they intervene on an ad hoc basis before ignoring important issues for long periods.
• They try to delegate and centralise simultaneously, for example via performance management based on metrics and targets.

We might also talk, yet again, about Brexit. If Brexit is in part a response to these problems of diminished control, what stories can we identify about how ministers plan to take it back? What, for example, are the Three Musketeers saying these days? And how much control can they take back, given that the EU is one small part of our discussion?

Illustrative example: (1) troubled families

I can tell you a quick story about ‘troubled families’ policy, because I think it sums up neatly the UK Government’s attempt to look in control of a process over which it has limited influence:

• It provides a simple story with a moral about who was to blame for the riots in England in 2011: bad parents and their unruly children (and perhaps the public sector professionals being too soft on them).
• It sets out an immediate response from the centre: identify the families, pump in the money, turn their lives around.
• But, if you look below the surface, you see the lack of control: it’s not that easy to identify ‘troubled families’, the government relies on many local public bodies to get anywhere, and few lives are actually being ‘turned around’.
• We can see a double whammy of ‘wicked problems’: the policy problem often seems impervious to government action, and there is a lack of central control of that action.
• So, governments focus on how they present their action, to look in control even when they recognise their limits.

Illustrative example: (2) prevention and early intervention

If you are still interested by this stage, look at this issue in its broader context, of the desire of governments to intervene early in the lives of (say) families to prevent bad things happening. With Emily St Denny, I ask why governments seem to make a sincere commitment to this task but fall far shorter than they expected. The key passage is here:

“Our simple answer is that, when they make a sincere commitment to prevention, they do not know what it means or appreciate scale of their task. They soon find a set of policymaking constraints that will always be present. When they ‘operationalise’ prevention, they face several fundamental problems, including: the identification of ‘wicked’ problems (Rittell and Webber, 1973) which are difficult to define and seem impossible to solve; inescapable choices on how far they should go to redistribute income, distribute public resources, and intervene in people’s lives; major competition from more salient policy aims which prompt them to maintain existing public services; and, a democratic system which limits their ability to reform the ways in which they make policy. These problems may never be overcome. More importantly, policymakers soon think that their task is impossible. Therefore, there is high potential for an initial period of enthusiasm and activity to be replaced by disenchantment and inactivity, and for this cycle to be repeated without resolution”.

Group exercise.

Here is what I’ll ask you to do this week:

• Describe the WM and CG stories in some depth in your groups, then we’ll compare your accounts.
• Think of historical and contemporary examples of decision-making which seem to reinforce one story or the other, to help us decide which story seems most convincing in each case.
• Try to describe the heroes/ villains in these stories, or their moral. For example, if the WM doesn’t explain the examples you describe, what should policymakers do about it? Will we only respect them if they refuse to give up, like Forest Gump or the ‘never give up, never surrender’ guy in Galaxy Quest? Or, if we would like to see pragmatic politicians, how would we sell their behaviour as equally heroic?

British politics, Brexit and UK sovereignty: what does it all mean? #POLU9UK

 This is the first of 10 blog posts for the course POLU9UK: Policy and Policymaking in the UK. They will be a fair bit longer than the blog posts I asked you to write. I have also recorded a short lecture to go with it (OK, 22 minutes isn’t short).

In week 1 we’ll identify all that we think we knew about British politics, compare notes, then throw up our hands and declare that the Brexit vote has changed what we thought we knew.

I want to focus on the idea that a vote for the UK to leave the European Union was a vote for UK sovereignty. People voted Leave/ Remain for all sorts of reasons, and bandied around all sorts of ways to justify their position, but the idea of sovereignty and ‘taking back control’ is central to the Leave argument and this module.

For our purposes, it relates to broader ideas about the images we maintain about who makes key decisions in British politics, summed up by the phrases ‘parliamentary sovereignty’ and the ‘Westminster model’, and challenged by terms such as ‘bounded rationality’, ‘policy communities’, ‘multi-level governance’, and ‘complex government’.

Parliamentary Sovereignty

UK sovereignty relates strongly to the idea of parliamentary sovereignty: we vote in constituencies to elect MPs as our representatives, and MPs as a whole represent the final arbiters on policy in the UK. In practice, one party tends to dominate Parliament, and the elected government tends to dominate that party, but the principle remains important.

So, ‘taking back control’ is about responding, finally, to the sense that (a) the UK’s entry to the European Union from 1972 (when it signed the accession treaty) involved giving up far more sovereignty than most people expected, and (b) the European Union’s role has strengthened ever since, at the further expense of parliamentary sovereignty.

The Westminster Model

This idea of parliamentary sovereignty connects strongly to elements of the ‘Westminster model’ (WM), a shorthand phrase to describe key ways in which the UK political system is designed to work.

Our main task is to examine how well the WM: (a) describes what actually happens in British politics, and (b) represents what should happen in British politics. We can separate these two elements analytically but they influence each other in practice. For example, I ask what happens when elected policymakers know their limits but have to pretend that they don’t.

What should happen in British politics?

Perhaps policymaking should reflect strongly the wishes of the public. In representative democracies, political parties engage each other in a battle of ideas, to attract the attention and support of the voting public; the public votes every 4-5 years; the winner forms a government; the government turns its manifesto into policy; and, policy choices are carried out by civil servants and other bodies. In other words, there should be a clear link between public preferences, the strategies and ideas of parties and the final result.

The WM serves this purpose in a particular way: the UK has a plurality (‘first past the post’) voting system which tends to exaggerate support for, and give a majority in Parliament to, the winning party. It has an adversarial (and majoritarian?) style of politics and a ‘winner takes all’ mentality which tends to exclude opposition parties. The executive resides in the legislature and power tends to be concentrated within government – in ministers that head government departments and the Prime Minister who heads (and determines the members of) Cabinet. The government is responsible for the vast majority of public policy and it uses its governing majority, combined with a strong party ‘whip’, to make sure that its legislation is passed by Parliament.

In other words, the WM narrative suggests that the UK policy process is centralised and that the arrangement reflects a ‘British political tradition’: the government is accountable to public on the assumption that it is powerful and responsible. So, you know who is in charge and therefore who to praise or blame, and elections every 4-5 years are supplemented by parliamentary scrutiny built on holding ministers directly to account.

Pause for further reading: at this point, consider how this WM story links to a wider discussion of centralised policymaking (in particular, read the 1000 Words post on the policy cycle).

What actually happens?

One way into this discussion is to explore modern discussions of disenchantment with distant political elites who seem to operate in a bubble and not demonstrate their accountability to the public. For example, there is a literature on the extent to which MPs are likely to share the same backgrounds: white, male, middle class, and educated in private schools and Oxford or Cambridge. Or, the idea of a ‘Westminster bubble’ and distant ‘political class’ comes up in discussions of constitutional change (including the Scottish referendum debate), and was exacerbated during the expenses scandal in 2009.

Another is to focus on the factors that undermine this WM image of central control: maybe Westminster political elites are remote, but they don’t control policy outcomes. Instead, there are many factors which challenge the ability of elected policymakers to control the policy process. We will focus on these challenges throughout the course:

Challenge 1. Bounded rationality

Ministers only have the ability to pay attention to a tiny proportion of the issues over which have formal responsibility. So, how can they control issues if they have to ignore them? Much of the ‘1000 Words’ series explores the general implications of bounded rationality.

Challenge 2. Policy communities

Ministers don’t quite ignore issues; they delegate responsibility to civil servants at a quite-low level of government. Civil servants make policy in consultation with interest groups and other participants with the ability to trade resources (such as information) for access or influence. Such relationships can endure long after particular ministers or elected governments have come and gone.

In fact, this argument developed partly in response to discussions in the 1970s about the potential for plurality elections to cause huge swings in party success, and therefore frequent changes of government and reversals of government policy. Rather, scholars such as Jordan and Richardson identified policy continuity despite changes of government (although see Richardson’s later work).

Challenge 3. Multi-level governance

‘Multi-level’ refers to a tendency for the UK government to share policymaking responsibility with international, EU, devolved, and local governments.

‘Governance’ extends the logic of policy communities to identify a tendency to delegate or share responsibility with non-governmental and quasi-non-governmental organisations (quangos).

So, MLG can describe a clear separation of powers at many levels and a fairly coherent set of responsibilities in each case. Or, it can describe a ‘patchwork quilt’ of relationships which is difficult to track and understand. In either case, we identify ‘polycentricity’ or the presence of more than one ‘centre’ in British politics.

Challenge 4. Complex government

The phrase ‘complex government’ can be used to describe the complicated world of public policy, with elements including:

• the huge size and reach of government – most aspects of our lives are regulated by the state
• the potential for ministerial ‘overload’ and need to simplify decision-making
• the blurry boundaries between the actors who make policy and those who seek to influence and/ or implement it (public policy results from their relationships and interactions)
• the multi-level nature of policymaking

• the complicated network of interactions between policy actors and many different ‘institutions’

 

• the complexity of the statute book and the proliferation of rules and regulations, many of which may undermine each other.

 

Overall, these factors generate a sense of complex government that challenges the Westminster-style notion of accountability. How can we hold elected ministers to account if:

1. they seem to have no hope of paying attention to much of complex government, far less control it
2. there is so much interaction with unpredictable effects
3. we don’t understand enough about how this process works to know if ministers are acting effectively?

Challenge 5. The policy environment and unpredictable events

Further, such governments operate within a wider environment in which conditions and events are often out of policymakers’ control. For example, how do they deal with demographic change or global economic crisis? Policymakers have some choice about the issues to which they pay attention, and the ways in which they understand and address them. However, they do not control that agenda or policy outcomes in the way we associate with the WM image of central control.

How has the UK government addressed these challenges?

We can discuss two key themes throughout the course:

1. UK central governments have to balance two stories of British politics. One is the need to be pragmatic in the face of these five challenges to their power and sense of control. Another is the need to construct an image of governing competence, and most governments do so by portraying an image of power and central control!
2. This dynamic contributes to state reform. There has been a massive build-up and partial knock-down of the ‘welfare state’ in the post-war period (please have a think about the key elements). This process links strongly to that idea of pragmatism versus central control: governments often reform the state to (a) deliver key policy outcomes (the development of the welfare state and aims such as full employment), or (b) reinvigorate central control (for example, to produce a ‘lean state’ or ‘hollowing state’).

What does this discussion tell us about our initial discussion of Brexit?

None of these factors help downplay the influence of the EU on the UK. Rather, they prompt us to think harder about the meaning, in practice, of parliamentary sovereignty and the Westminster model which underpins ongoing debates about the UK-EU relationship. In short, we can explore the extent to which a return to ‘parliamentary sovereignty’ describes little more than principles not evidence in practice. Such principles are important, but let’s also focus on what actually happens in British politics.

 

We need better descriptions than ‘evidence-based policy’ and ‘policy-based evidence’: the case of UK government ‘troubled families’ policy

Here is the dilemma for ‘evidence-based’ ‘troubled families’ policy: there are many indicators of ‘policy based evidence’ but few (if any) feasible and ‘evidence based’ alternatives.

Viewed from the outside, TF looks like a cynical attempt to produce a quick fix to the London riots, stigmatise vulnerable populations, and hoodwink the public into thinking that the central government is controlling local outcomes and generating success.

Viewed from the inside, it is a pragmatic policy solution, informed by promising evidence which needs to be sold in the right way. For the UK government there may seem to be little alternative to this policy, given the available evidence, the need to do something for the long term and to account for itself in a Westminster system in the short term.

So, in this draft paper, I outline this disconnect between interpretations of ‘evidence based policy’ and ‘policy based evidence’ to help provide some clarity on the pragmatic use of evidence in politics:

cairney-offshoot-troubled-families-ebpm-5-9-16

See also:

Governments think it’s OK to use bad evidence to make good policy: the case of the UK Government’s ‘troubled families’

Early intervention policy, from ‘troubled families’ to ‘named persons’: problems with evidence and framing ‘valence’ issues

In each of these posts, I note that it is difficult to know how, for example, social policy scholars should respond to these issues – but that policy studies help us identify a choice between strategies. In general, pragmatic strategies to influence the use of evidence in policy include: framing issues to catch the attention or manipulate policymaker biases, identifying where the ‘action’ is in multi-level policymaking systems, and forming coalitions with like-minded and well-connected actors. In other words, to influence rather than just comment on policy, we need to understand how policymakers would respond to external evaluation. So, a greater understanding the routine motives of policymakers can help produce more effective criticism of its problematic use of evidence. In social policy, there is an acute dilemma about the choice between engagement, to influence and be influenced by policymakers, and detachment to ensure critical distance. If choosing the latter, we need to think harder about how criticism of PBE makes a difference.

Early intervention policy, from ‘troubled families’ to ‘named persons’: problems with evidence and framing ‘valence’ issues

Imagine this as your ‘early intervention’ policy choice: (a) a universal and non-stigmatising programme for all parents/ children, with minimal evidence of effectiveness, high cost, and potential public opposition about the state intervening in family life; or (b) a targeted, stigmatising programme for a small number, with more evidence, less cost, but the sense that you are not really intervening ‘early’ (instead, you are waiting for problems to arise before you intervene). What would you do, and how would you sell your choice to the public?

I ask this question because ‘early intervention’ seems to the classic valence issue with a twist. Most people seem to want it in the abstract: isn’t it best to intervene as early as possible in a child’s life to protect them or improve their life chances?

However, profound problems or controversies arise when governments try to pursue it. There are many more choices than I presented, but the same basic trade-offs arise in each case. So, at the start, it looks like you have lucked onto a policy that almost everyone loves. At the end, you realise that you can’t win. There is no such thing as a valence issue at the point of policy choice and delivery.

To expand on these dilemmas in more depth, I compare cases of Scottish and UK Government ‘families policies’. In previous posts, I portrayed their differences – at least in the field of prevention and early intervention policies – as more difficult to pin down than you might think. Often, they either say the same things but ‘operationalise’ them in very different ways, or describe very different problems then select very similar solutions.

This basic description sums up very similar waves of key ‘families policies’ since devolution: an initial focus on social inclusion, then anti-social behaviour, followed by a contemporary focus on ‘whole family’ approaches and early intervention. I will show how they often go their own ways, but note the same basic context for choice, and similar choices, which help qualify that picture.

Early intervention & prevention policies are valence issues …

A valence (or ‘motherhood and apple pie’) issue is one in which you can generate huge support because the aim seems, to most people, to be obviously good. Broad aims include ‘freedom’ and ‘democracy’. In the UK specific aims include a national health service free at the point of use. We often focus on valence issues to highlight the importance of a political party’s or leader’s image of governing competence: it is not so much what we want (when the main parties support very similar things), but who you trust to get it.

Early intervention seems to fit the bill: who would want you to intervene late or too late in someone’s life when you can intervene early, to boost their life chances at an early stage as possible? All we have to do is work out how to do it well, with reference to some good evidence. Yet, as I discuss below, things get complicated as soon as we consider the types of early intervention available, generally described roughly as a spectrum from primary (stop a problem occurring and focus on the whole population – like a virus inoculation) to secondary (address a problem at an early stage, using proxy indicators to identify high-risk groups), and tertiary (stop a problem getting worse in already affected groups).

Similarly, look at how Emily St Denny and I describe prevention policy. Would many people object to the basic principles?

“In the name of prevention, the UK and Scottish Governments propose to radically change policy and policymaking across the whole of government. Their deceptively simple definition of ‘prevention policy’ is: a major shift in resources, from the delivery of reactive public services to solve acute problems, to the prevention of those problems before they occur. The results they promise are transformative, to address three crises in politics simultaneously: a major reduction in socioeconomic equalities by focusing on their ‘root causes’; a solution to unsustainable public spending which is pushing public services to breaking point; and, new forms of localised policymaking, built on community and service user engagement, to restore trust in politics”.

… but the evidence on their effectiveness is inconvenient …

A good simple rule about ‘evidence-based policymaking’ is that there is never a ‘magic bullet’ to tell you what to do or take the place of judgement. Politics is about making choices which benefit some people while others lose out. You can use evidence to help clarify those choices, but not produce a ‘technical’ solution. A further rule with ‘wicked’ problems is that the evidence is not good enough even to generate clarity about the cause of the problem. Or, you simply find out things you don’t want to hear.

Early intervention seems to be a good candidate for the latter, for three main reasons:

1. Very few interventions live up to high evidence standards

There are two main types of relevant ‘evidence based’ interventions in this field. The first are ‘family intervention projects’ (FIPs). They generally focus on low income, often lone parent, families at risk of eviction linked to factors such as antisocial behaviour, and provide two forms of intervention: intensive 24/7 support, including after school clubs for children and parenting skills classes, and treatment for addiction or depression in some cases, in dedicated core accommodation with strict rules on access and behaviour; and an outreach model of support and training. The evidence of success comes from evaluation and a counterfactual: this intervention is expensive, but we think that it would have cost far more money and heartache if we had not intervened to prevent (for example) family homelessness. There is generally no randomised control trial (RCT) to establish the cause of improved outcomes, or demonstrate that those outcomes would not have happened without an intervention of this sort.

The second are projects imported from other countries (primarily the US and Australia) based on their reputation for success. This reputation has been generated according to evidential rules associated with ‘evidence based medicine’ (EBM), in which there is relatively strong adherence to a hierarchy of evidence, with RCTs and their systematic review at the top, and the belief that there should be ‘fidelity’ to programmes to make sure that the ‘dosage’ of the intervention is delivered properly and its effect measured. Key examples include the Family Nurse Partnership (although its first UK RCT evaluation was not promising), Triple P (although James Coyne has his doubts!), and Incredible Years (but note the importance of ‘indicated’ versus ‘selective’ programmes, below). In this approach, there may be more quantitative evidence of success, but it is still difficult to know if the project can be transferred effectively and if its success can be replicated in another country with a very different political drivers, problems, and levels of existing services. We know that some interventions are associated with positive outcomes, but we struggle to establish definitively that they caused them (solely, separate from their context).

2. The evidence on ‘scaling up’ for primary prevention is relatively weak

Kenneth Dodge (2009) sums up a general problem with primary prevention in this field. It is difficult to see much evidence of success because: there are few examples of taking effective specialist projects ‘to scale’; there are major issues around ‘fidelity’ to the original project when you scale up (including the need to oversee a major expansion in well-trained practitioners); and, it is difficult to predict the effect of a programme, which showed promise when applied to one population, to a new and different population.

3. The evidence on secondary early intervention is also weak

This point about different populations with different motivations is demonstrated in a more recent (published 2014) study by Stephen Scott et al of two Incredible Years interventions – to address ‘oppositional defiant disorder symptoms and antisocial personality character traits’ in children aged 3-7 (for a wider discussion of such programmes see the Early Intervention Foundation’s Foundations for life: what works to support parent child interaction in the early years?).

They highlight a classic dilemma in early intervention: the evidence of effectiveness is only clear when children have been clinically referred (‘indicated approach’), but unclear when children have been identified as high risk using socioeconomic predictors (‘selective approach’):

An indicated approach is simpler to administer, as there are fewer children with severe problems, they are easier to identify, and their parents are usually prepared to engage in treatment; however, the problems may already be too entrenched to treat. In contrast, a selective approach targets milder cases, but because problems are less established, whole populations have to be screened and fewer cases will go on to develop serious problems.

For our purposes, this may represent the most inconvenient form of evidence on early intervention: you can intervene early on the back of very limited evidence of likely success, or have a far higher likelihood of success when you intervene later, when you are running out of time to call it ‘early intervention’.

… so governments have to make and defend highly ‘political’ choices …

I think this is key context in which we can try to understand the often-different choices by the UK and Scottish Governments. Faced with the same broad aim, to intervene early to prevent poor outcomes, the same uncertainty and lack of evidence that their interventions will produce the desired effect, and the same need to DO SOMETHING rather than wait for the evidence that may never arise, what do they do?

Both governments often did remarkably similar things before they did different things

From the late 1990s, both governments placed primary emphasis initially on a positive social inclusion agenda, followed by a relatively negative focus on anti-social behaviour (ASB), before a renewed focus on the social determinants of inequalities and the use of early intervention to prevent poor outcomes.

Both governments link families policies strongly to parenting skills, reinforcing the idea that parents are primarily responsible for the life chances of their children.

Both governments talk about getting away from deficit models of intervention (the Scottish Government in particular focuses on the ‘assets’ of individuals, families, and communities) but use deficit-model proxies to identify families in need of support, including: lone parenthood, debt problems, ill health (including disability and depression), and at least one member subject to domestic abuse or intergenerational violence, as well as professional judgements on the ‘chaotic’ or ‘dysfunctional’ nature of family life and of the likelihood of ‘family breakdown’ when, for example, a child it taken into care.

So, when we consider their headline-grabbing differences, note this common set of problems and drivers, and similar responses.

… and selling their early intervention choices is remarkably difficult …

Although our starting point was valence politics, prevention and early intervention policies are incredibly hard to get off the ground. As Emily St Denny and I describe elsewhere, when policymakers ‘make a sincere commitment to prevention, they do not know what it means or appreciate the scale of their task. They soon find a set of policymaking constraints that will always be present. When they ‘operationalise’ prevention, they face several fundamental problems, including: the identification of ‘wicked’ problems which are difficult to define and seem impossible to solve; inescapable choices on how far they should go to redistribute income, distribute public resources, and intervene in people’s lives; major competition from more salient policy aims which prompt them to maintain existing public services; and, a democratic system which limits their ability to reform the ways in which they make policy. These problems may never be overcome. More importantly, policymakers soon think that their task is impossible. Therefore, there is high potential for an initial period of enthusiasm and activity to be replaced by disenchantment and inactivity, and for this cycle to be repeated without resolution’.

These constraints refer to the broad idea of prevention policy, while specific policies can involve different drivers and constraints. With general prevention policy, it is difficult to know what government policy is and how you measure its success. ‘Prevention’ is vague, plus governments encourage local discretion to adapt the evidence of ‘what works’ to local circumstances.

Governments don’t get away with this regarding specific policies. Instead, Westminster politics is built on a simple idea of accountability in which you know who is in charge and therefore to blame. UK central governments have to maintain some semblance of control because they know that people will try to hold them to account in elections and general debate. This ‘top down’ perspective has an enduring effect, particularly in the UK, but also the Scottish, government.

… so the UK Government goes for it and faces the consequences ….

‘Troubled Families’ in England: the massive expansion of secondary prevention?

So, although prevention policy is vague, individual programmes such as ‘troubled families’ contain enough detail to generate intense debate on central government policy and performance and contain elements which emphasise high central direction, including sustained ministerial commitment, a determination to demonstrate early success to justify a further rollout of policy, and performance management geared towards specific measurable short term outcomes – even if the broader aim is to encourage local discretion and successful long term outcomes.

In the absence of unequivocally supportive evidence (which may never appear), the UK government relied on a crisis (the London riots in 2011) to sell policy, and ridiculous processes of estimation of the size of the problem and performance measurement to sell the success of its solution. In this system, ministers perceive the need to display strength, show certainty that they have correctly diagnosed a problem and its solution, and claim success using the ‘currency’ of Westminster politics – and to do these things far more quickly than the people gathering evidence of more substantive success. There is a lot of criticism of the programme in terms of its lack, or cynical use, of evidence but little of it considers policy from an elected government’s perspective.

…while the Scottish Government is more careful, but faces unintended consequences

This particular UK Government response has no parallel in Scotland. The UK Government is far more likely than its Scottish counterpart to link families policies to a moral agenda in response to crisis, and there is no Scottish Government equivalent to ‘payment by results’ and massive programme expansion. Instead, it continued more modest roll-outs in partnership with local public bodies. Indeed, if we ‘zoom in’ to this one example, at this point in time, the comparison confirms the idea of a ‘Scottish Approach’ to policy and policymaking.

Yet, the Scottish Government has not solved the problems I describe in this post: it has not found an alternative ‘evidence based’ way to ‘scale up’ early intervention significantly and move from secondary/ tertiary forms of prevention to the more universal/ primary initiatives that you might associate intuitively with prevention policy.

Instead, its different experiences have highlighted different issues. For example, its key vehicle for early intervention and prevention is the ‘collaborative’ approach, such as in the Early Years Collaborative. Possibly, it represents the opposite of the UK’s attempt to centralise and performance-manage-the-hell-out-of the direction of major expansion.

Certainty, with this approach, your main aim is not to generate evidence of the success of interventions – at least not in the way we associate with ‘evidence based medicine’, randomised control trials, and the star ratings developed by the Early Intervention Foundation. Rather, the aim is to train local practitioners to use existing evidence and adapt it to local circumstances, experimenting as you go, and gathering/using data on progress in ways not associated with, for example, the family nurse partnership.

So, in terms of the discussion so far, perhaps its main advantage is that a government does not have to sell its political choices (it is more of a delivery system than a specific intervention) or back them up with evidence of success elsewhere. In the absence of much public, media, or political party attention, maybe it’s a nice pragmatic political solution built more on governance principles than specific evidence.

Yet, despite our fixation with the constitution, some policy issues do occasionally get discussed. For our purposes, the most relevant is the ‘named person’ scheme because it looks like a way to ‘scale up’ an initiative to support a universal or primary prevention approach and avoid stigmatising some groups by offering a service to everyone (in this respect, it is the antithesis to ‘troubled families’). In this case, all children in Scotland (and their parents or guardians) get access to a senior member of a public service, and that person acts as a way to ‘join up’ a public sector response to a child’s problems.

Interestingly, this universal approach has its own problems. ‘Troubled families’ sets up a distinction between troubled/ untroubled to limit its proposed intervention in family life. Its problem is the potential to stigmatise and demoralise ‘troubled’ families. ‘Named person’ shows the potential for greater outcry when governments try to not identify and stigmatise specific families. The scheme is largely a response to the continuous suggestion – made after high profile cases of child abuse or neglect – that children can suffer when no agency takes overall responsibility for their care, but has been opposed as excessive infringement on normal family life and data protection, successfully enough to delay its implementation.

[Update 20.9.19: Named person scheme scrapped by Scottish Government]

The punchline to early intervention as a valence issue

Problems arise almost instantly when you try to turn a valence issue into something concrete. A vague and widely-supported policy, to intervene early to prevent bad outcomes, becomes a set of policy choices based on how governments frame the balance between ideology, stigma, and the evidence of the impact and cost-effectiveness of key interventions (which is often very limited).

Their experiences are not always directly comparable, but the UK and Scottish Governments have helped show us the pitfalls of concrete approaches to prevention and early intervention. They help us show that your basic policy choices include: (a) targeted programmes which increase stigma, (b) ‘indicated’ approaches which don’t always look like early intervention; (c) ‘selective’ approaches which seem to be less effective despite intervening at an earlier stage, (d) universal programmes which might cross a notional line between the state and the family, and (e) approaches which focus primarily on local experimentation with uncertain outcomes.

None of these approaches provide a solution to the early intervention dilemmas that all governments face, and there is no easy way to choose between approaches. We can make these choices more informed and systematic, by highlighting how all of the pieces of the jigsaw fit together, and somehow comparing their intended and unintended consequences. However, this process does not replace political judgement – and quite right too – because there is no such thing as a valence issue at the point of policy choice and delivery.

See also:

Paul Cairney (2019) ‘The UK government’s imaginative use of evidence to make policy’, British Politics, 14, 1, 1-22 Open Access PDF

Paul Cairney and Emily St Denny (in press, January 2020) Why Isn’t Government Policy More Preventive? (Oxford: Oxford University Press) Preview Introduction Preview Conclusion